RESUMO
The purpose of the study reported here was to compare the bactericidal effectiveness of tetracycline and co-trimoxazole (a combination of sulfamethoxazole and trimethoprim) in treating cholera. The study, an open-ended random trial using adult patients with cholera cases confirmed by stool culture, was carried out in March 1993 at the Cholera Treatment Unit (CTU) of the Hospital de Apoyo Departmental María Auxiliadora in Lima, Peru. A total of 107 subjects were divided into two groups (A and B). The 50 in Group A received 500 mg of tetracycline orally every 6 hours for 3 days; the 57 in Group B received co-trimoxazole (160 mg of trimethoprim and 800 mg of sulfamethoxazole) orally every 12 hours for 3 days. The two groups were comparable in terms of age, sex, duration of symptoms prior to hospital admission, time at which antibiotic treatment was initiated, and clinical evolution. Control stool cultures of specimens obtained after treatment showed Vibrio cholerae O-1 present in 2% of the Group A and 12.3% of the Group B patients, and also showed V. cholerae non-O-1 present in 2% of the Group A patients and 3.5% of the Group B patients. Overall, it was concluded that both therapeutic treatment regimens were effective and that the strains of V. cholerae observed in the southern sector of the city of Lima were still susceptible to both antibiotics.
Assuntos
Antibacterianos/uso terapêutico , Cólera/tratamento farmacológico , Tetraciclina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adolescente , Adulto , Cólera/microbiologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Resistência a TetraciclinaRESUMO
A retrospective review was conducted of the clinical histories of 43 pregnant women treated for acute diarrheal disease in the emergency ward of the María Auxiliadora Departmental Hospital (HADMA) in Lima, Peru, and 32 of the histories were selected for this study. These 32 patients had been admitted to the cholera treatment unit (CTU) of the HADMA for acute choleraic diarrhea with moderate or severe dehydration. The objective was to analyze the clinical evolution of the patients, their response to isotonic rehydration therapy (0.9% saline solution), and the consequences for their pregnancies. The following variables were examined: age; trimester of pregnancy; heart rate and mean blood pressure (MBP) at admission; number of hours since last normal urination; duration of diarrhea; degree of dehydration; volume of diarrhea and vomiting; volume of saline solution administered in the first 2 hours and in total; volume of multi-electrolyte solution (MES) or oral rehydration salts (ORS) administered from the second to the sixth hour and in total; and hours between admission to the emergency ward and transfer to the cholera treatment unit (EME/CTU). Logistic regression analysis revealed a direct and statistically significant correlation between the time of recovery of diuresis and the EME/CTU (P = 0.001; r = 0.65), as well as between time of recovery of diuresis and the volume of diarrhea in the first 4 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cólera/terapia , Diarreia/terapia , Hidratação , Complicações Infecciosas na Gravidez/terapia , Doença Aguda , Adolescente , Adulto , Cólera/complicações , Desidratação/etiologia , Desidratação/terapia , Diarreia/complicações , Feminino , Humanos , Hipotensão/etiologia , Hipotensão/terapia , Oligúria/etiologia , Oligúria/terapia , Peru , Gravidez , Resultado da Gravidez , Análise de Regressão , Estudos Retrospectivos , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/terapiaRESUMO
We report the pharmacokinetic parameters of ceftriaxone in 11 patients on hemodialysis with end-stage renal disease (ESRD; creatinine clearance less than 5 ml/min/1.73 m2). The patients were studied during the interdialysis period and during 4 h of hemodialysis. The mean age was 53.4 years. After the administration of 1 g of ceftriaxone during a constant intravenous infusion over a 30-min period, t 1/2 was 16.6 h, beta was 0.0418 +/- 0.0106 h-1, VD was 14.5 +/- 3.0 liters/1.73 m2 and Clp was 0.40 +/- 0.05 liters/h for the interdialysis period. Hemodialysis started 24 h after the infusion. The initial plasma ceftriaxone concentration was 68.6 +/- 10.8 micrograms/ml. This value dropped to 40.4 +/- 4.7 micrograms/ml at the end of the 4th hour, indicating a significant 41% decay in blood levels during hemodialysis (p less than 0.001). The t 1/2 decreased to 4.88 h, kel rose to 0.142 +/- 0.0250 h-1 and Clp increased to 1.73 +/- 0.44 liters/h. All values were highly significantly different (p less than 0.001) from those during the interdialysis period. The plasma ceftriaxone concentration of 40.4 +/- 4.7 micrograms/ml at the end of hemodialysis was well within the therapeutic range of the drug. We conclude that ceftriaxone has a moderated increase in t 1/2 in patients with ESRD. Ceftriaxone is significantly dialyzable, however, the plasma concentrations are in the therapeutic range by the end of a 4-hour hemodialysis, 28 h after the administration of the drug. We propose that 1 g given intravenously before each hemodialysis will be sufficient to keep the patient's plasma concentrations within the therapeutic range until the next hemodialysis.(ABSTRACT TRUNCATED AT 250 WORDS)