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In a prospective, randomized, double-blind, multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome (RDS) in preterm infants. The dose of betamethasone was 4 mg every 8 h for six doses, unless delivery occurred. The 251 women who were enrolled gave birth to 262 liveborn infants, 130 in the beta-methasone and 132 in the placebo group; the two groups were evenly matched in most respects. The diagnosis of RDS in the newborn was confirmed by two independent assessors. Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo group developed RDS. In infants whose mothers had received at least three injections, RDS was also less frequent in the steroid group than in the placebo group (3/104 and 10/104 respectively; P less than 0.05). There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial (0/30 and 8/45 respectively; P less than 0.05). The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation, within 8 days of trial entry, and whose mothers had received at least three injections (0/27 steroid group and 7/32 placebo group; P = 0.03), and there were also significantly fewer neonatal deaths (2/27 and 13/32, respectively; P less than 0.01) in this subgroup. Betamethasone did not provoke earlier delivery. Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids: there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group. Neonatal jaundice was significantly less frequent in the steroid (55/129) than in the placebo group (81/127; P less than 0.01) but not in the subgroups born before 34 completed weeks gestation.

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Twenty-six patients with a malignancy who were receiving intermittent cytotoxic chemotherapy acquired putative bacterial infections while neutropenic. Fourteen patients with neutrophil counts less than 100 X 10(6)/L received cefuroxime plus amikacin. Twelve patients with neutrophil counts between 100 and 500 X 10(6)/L were given cefuroxime alone. The dosages were amikacin, 500 mg BID, and cefuroxime, 1.5 gm TID, although the dose of cefuroxime was halved in three patients because of low body weight and in one patient because of impaired renal function. Bacteriological proof of infection was obtained in 14 patients. In all but two, the bacteria were eradicated by therapy; those two had strains resistant to cefuroxime. Clinical cure was obtained in 15 patients (58%); marked improvement, in seven (27%). One of the patients not cured was probably not infected. In another, the organism was eradicated but the patient did not recover from preexisting shock and renal failure. There were minimal side effects. One patient had diarrhea, one complained of pain on injection, and two had slight increases in transaminase levels. Of particular note is the lack of renal toxicity, particularly in the five patients previously treated with cisplatin.

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The transfer of cefuroxime across the placenta was studied in 10 women in labour and 12 women being delivered by Caesarean section. Following a single intramuscular injection of 750 mg cefuroxime, high antibiotic concentrations were found in the amniotic fluid in women in labour; the peak concentration of 18 mg/l was achieved after five hours. Therapeutic concentrations of cefuroxime were present in umbilical vein serum for up to eight hours after injection. A similar pharmacokinetic picture was observed in the women undergoing Caesarean section although in the limited time interval (up to four hours) between injection and delivery the amniotic fluid levels of cefuroxime achieved were lower. Cefuroxime appears to cross the placenta well to produce effective concentrations in fetal blood and amniotic fluid.

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The placental transfer of cefuroxime was studied in 20 women after one or more 1.5 g intravenous injections. Ten women had labour induced at term and ten were delivered by elective Caesarean section. High concentrations of cefuroxime were found in the cord blood and amniotic fluid and therapeutically active antibiotic levels were found in the infants for up to six hours after delivery.

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Cefuroxime and ampicillin were compared in a randomized double-blind trial in the treatment of severe lower respiratory tract infections. 750 mg of cefuroxime were given to 57 patients and 500 mg of ampicillin to 54 patients by intramuscular injection three times daily for 7-10 days. The patients had acute exacerbations of chronic bronchitis with or without pneumonia, a few had bronchiectasis and an underlying bronchial carcinoma was present in nearly a quarter. By the end of treatment the sputum, initially always mucopurulent, had become mucoid in 87.7% of patients receiving cefuroxime in comparison to 48.1% of those receiving ampicillin. A satisfactory clinical response was observed in 94.7 and 68.5%, respectively. Both these differences between cefuroxime and ampicillin are statistically significant (p less than 0.001).

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One hundred seventy-eight men and women with acute gonorrhea were treated by intramuscular administration of cefuroxime. Use of 1 g of cefuroxime plus 1 g of probenecid gave a cure rate of 95.5%, which compared well with that of a standard treatment of 5 x 10(6) units of intramuscularly administered benzyl penicillin plus 1 g of probenecid. The latter gave a cure rate of 97.2% in a concurrent series of 178 patients. A subsequent comparison of 163 patients who received 750 mg of cefuroxime plus 1 g of probenecid with 145 patients who received 1.5 g of cefuroxime alone showed cure rates of 95.1% and 97.2%, respectively. Only two cases of possible hypersensitivity to cefuroxime were found. It is concluded that cefuroxime is a valuable drug for single-session treatment of acute gonorrhea in both men and women.

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Cefuroxime is a very effective agent for the treatment of severe purulent respiratory infections. 190 patients with purulent exacerbations of bronchitis or bronchiectasis, pneumonia or secondarily infected lung cancer received 2.25--3.0 g cefuroxime daily for an average of 9 days. A good clinical response was seen in 91% of 184 assessable patients. A remarkable improvement in sputum purulence was observed and side-effects to cefuroxime were minimal.

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A double-blind study was carried out to investigate the prophylactic use of single-dose cefuroxime in elective abdominal surgery. Twenty-three patients received 1.5 g cefuroxime by intravenous injection immediately prior to induction of anaesthesia; 24 patients received no antibiotics. In the cefuroxime group, there were no cases of post-operative wound sepsis or septicaemia; in the control group, the incidence of these infections was 12.5% and 8.3% respectively.

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Cefuroxime is a new parenteral antibiotic with a wider spectrum of activity than earlier cephalosporins and is particularly active against Haemophilus influenzae, including strains resistant to ampicillin due to beta-lactamase production. From 18 centres, 274 patients suffering with 275 infections were treated with cefuroxime sodium using the standard regimen of 750 mg 8-hourly by intramuscular injection. The clinical results showed a 90% success rate in the patients with bronchopneumonia (105), 91% in patients with post-operative pneumonia (74), and 89% in the patients with acute exacerbations of chronic bronchitis (96). Renal function was closely monitored during therapy, and no adverse changes attributable to cefuroxime therapy were seen in any patient, including those who also received frusemide. Two patients (0.7%) developed a rash, although 8 penicillin-allergic patients were treated without incident. From these studies, it can be concluded that 750 mg cefuroxime 8-hourly is effective in the treatment of lower respiratory tract infections. It is suggested that the attributes of this antibiotic may offer several advantages over existing therapies.

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'Universal strength' BCG vaccine was given to 219 neonates and 2 months later 159 infants were Mantoux-tested with 5 Tu PPD-S and their BCG scars measured. The results showed a satisfactory conversion rate of over 90%. Though 30% of the lesions discharged, this only lasted for a few days and the vaccine was well tolerated and acceptable for use in neonates.

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Seven hundred and ninety-three tuberculin-negative school-children were vaccinated with BCG vaccine prepared from either the 1077 substrain, at 0-3 mg/ml moist weight, or the 1331 substrain at 0-15 and 0-3 mg/ml moist weight. Local vaccination reactions and Mantoux tuberculin conversion were measured. There were no differences between the 1077 vaccine and the lower strength 1331 vaccine. The more potent 1331 product, however, produced marginally larger vaccination lesions and a slightly increased tuberculin allergy. The small increase in size of the vaccination lesions was considered acceptable and vaccine of this type would be satisfactory for use in the United Kingdom.

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