brl-28500 and Acute-Disease

Ertapenem, a group I carbapenem antibiotic, has been shown to be safe and effective in treating adults with complicated intra-abdominal (cIAI) or acute pelvic infection (API). This study evaluated ertapenem for treating these infections in children.. In an open-label study, children aged 2 to 17 years with cIAI or API were randomized 3:1 to receive ertapenem or ticarcillin/clavulanate. Children 13 to 17 years of age received 1 g parenterally daily, and those 2 to 12 years of age received 15 mg/kg twice daily. Patients < 60 kg received ticarcillin/clavulanate 50 mg/kg 4 to 6 times daily and 3.1 g 4 to 6 times daily for those > or = 60 kg. Patients were assessed for safety and tolerability throughout the study and for efficacy after the completion of therapy.. One hundred five patients, 72 (69%) with cIAI, received > or = 1 dose of study drug and were included in the safety analysis. Eighty-one patients were treated with ertapenem. Infusion site pain was the most common drug-related adverse event in both groups. In the modified intent-to-treat analysis, the age-adjusted posttreatment clinical response rates were 87% (43/50 patients) and 100% (25/25 patients) in the cIAI and API patients, respectively, for ertapenem and 73% (11/15 evaluable patients) and 100% (8/8 evaluable patients), respectively, for ticarcillin/clavulanate. Overall age-adjusted response rates were 91% (68/75 evaluable patients) for ertapenem and 83% (19/23 evaluable patients) for the comparator.. This study suggests that ertapenem is generally safe and efficacious for treating cIAI or API in pediatric patients.

Topics: Abdominal Cavity; Acute Disease; Adolescent; Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Child; Child, Preschool; Clavulanic Acids; Ertapenem; Female; Humans; Male; Pelvis; Prospective Studies; Ticarcillin

Efficacy of ticarcillin/clavulanate was studied in the treatment of 11 patients with severe community- and hospital-acquired pneumonia in an open controlled trial. The drug was administered in a dose of 3.1 g every 4 or 6 hours depending on the infection severity. When pneumonia was due to Pseudomonas aeruginosa, amikacin was additionally used. The positive clinical effect of ticarcillin/clavulanate was stated in 73 per cent of the patients. The pathogen eradication was stated in all the patients. However, in 2 cases superinfection due to P.aeruginosa developed. Mild adverse effects were observed in 2 cases. It is concluded that ticarcillin/clavulanate is highly efficient in the treatment of patients with severe or complicated pneumonia. In cases with ventilator-associated pneumonia it is advisable to use ticarcillin/clavulanate in combination with an aminoglycoside.

Topics: Acute Disease; Adolescent; Adult; Clavulanic Acids; Community-Acquired Infections; Cross Infection; Drug Therapy, Combination; Humans; Lung Abscess; Middle Aged; Pneumonia, Bacterial; Ticarcillin; Time Factors

In a randomized comparative study, 116 patients with acute bacterial infections were treated with timentin (ticarcillin plus clavulanic acid) or a comparative agent (piperacillin for respiratory or urinary tract infections, and moxalactam for soft tissue infections). There were 91 clinically evaluated infections (timentin, 46; piperacillin, 29; moxalactam, 16). Twelve patients were bacteremic. A satisfactory clinical response occurred in all 46 patients treated with timentin and in 42 of the 45 treated with a comparative agent. Two clinical failures were due to superinfection (a Staphylococcus aureus pneumonia in the piperacillin group and an enterococcal skin infection in the moxalactam group), and one clinical failure was due to a primary S. aureus skin infection (moxalactam group). One wound isolate of Pseudomonas aeruginosa developed resistance to timentin during therapy (despite clinical improvement). Adverse reactions were uncommon but did include one patient treated with timentin who developed unexplained hallucinations.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Bacterial Infections; Clavulanic Acids; Drug Combinations; Female; Hallucinations; Humans; Male; Middle Aged; Moxalactam; Penicillins; Piperacillin; Sepsis; Ticarcillin

Topics: Acute Disease; Adolescent; Adult; Clavulanic Acids; Drug Therapy, Combination; Epiglottitis; Female; Humans; Laryngitis; Male; Ticarcillin

Acute infection with the human immunodeficiency virus (HIV) is often characterised by a mononucleosis-like syndrome. We describe a patient who presented with the typical febrile syndrome associated with acute HIV infection, who also had significant granulocytopenia. Although granulocytopenia is relatively common in the later stages of HIV infection, it has only been described once before in the acute stage. The mechanism may be immune mediated, although data are limited. Clinicians should be aware of acute HIV infection as a possible cause of granulocytopenia.

Topics: Acute Disease; Adult; Agranulocytosis; Clavulanic Acids; Diagnosis, Differential; Drug Therapy, Combination; Fever; Gentamicins; HIV Infections; Humans; Male; Substance Abuse, Intravenous; Ticarcillin

Alerted by a high incidence of positive autologous controls in pretransfusion compatibility testing for patients with acute leukemia, we retrospectively analysed 59 cases of severe hemoblastoses undergoing myelosuppressive treatment. Seventeen (29%) of these patients had a positive direct antiglobulin test (DAT) with the following characteristics: the test was of the IgG and/or C3d type in all but two cases, which reacted with polyvalent antiglobulin sera only; the reaction was very weak throughout; very high concentrations of monospecific sera were needed to elicit positive reactions; free antibodies were never detected in the patients' serum; the eluates of the patients' red cells were non-reactive against a very large panel of test erythrocytes. All these criteria suggested a non-immunologic absorption of proteins under the influence of drugs such as cephalosporins and clavulanic acid. Timenten (ticarcillin and clavulanic acid) was found to be the only common drug which had been administered to the majority of the patients with a positive DAT: 15 of the 17 patients with a positive DAT (88%) had received Timenten against 19 of 42 patients (45%) with negative DAT. 44% of all the patients receiving Timenten thus had a positive DAT, whereas only 8% of the patients without this drug reacted in this way. These data document the role of clavulanic acid in the development of a positive DAT. The literature and our experience show that this kind of unspecific binding of proteins to the red cell membrane is not associated with increased hemolysis. Knowledge of the phenomenon, however, is important for differential diagnosis of anemias and interpretation of difficulties arising during pretransfusional compatibility testing.

Topics: Acute Disease; Adolescent; Adult; Aged; Antibody Affinity; Blood Grouping and Crossmatching; Child; Clavulanic Acids; Complement C3; Coombs Test; Drug Therapy, Combination; Erythrocyte Membrane; Female; Humans; Immunoglobulin G; Isoantibodies; Leukemia; Male; Middle Aged; Myelodysplastic Syndromes; Penicillins; Retrospective Studies; Ticarcillin

Sixty-four severe infections in hospitalized patients were treated with intravenous Timentin. Most patients (mean age: 50.5 years, range 18-85) had serious underlying conditions such as agranulocytosis, heart failure, cancer, diabetes mellitus, chronic alcoholism or other functional or anatomical abnormalities. Forty-three episodes were bacteriologically proved, and bacteraemia was diagnosed in 18. The sites of infection were: lower respiratory tract (10), upper respiratory tract (10), soft tissues (9), urinary tract (7), bones (6), peritoneal cavity (3), meninges (1) and pelvis (1). In addition, 13 episodes of fever and four of septicaemia in patients with agranulocytosis were treated with Timentin plus amikacin. Overall, 59% of the episodes were cured, 14% improved and 17% failed to respond. In 9% of cases the efficacy of the Timentin was unassessable mainly because of concurrent administration of other antimicrobials. Failure appeared to be more frequent in soft tissue and intra-abdominal infections, in patients infected with bacteria susceptible to Timentin but resistant to ticarcillin and in patients superinfected with Timentin-resistant strains. Major side effects were haemorrhagic diathesis with platelet dysfunction (1), severe water sodium overload (1), and possibly pancreatitis (1). Other side effects were mild: catheter-related phlebitis, and abnormal but clinically insignificant laboratory test results. Timentin appears to be an effective and safe broad-spectrum combination which compares favourably with third-generation cephalosporins in the treatment of severe hospital infections. More experience is needed to decide whether the somewhat lower response rate in patients infected with ticarcillin-resistant strains is significant.

Topics: Acute Disease; Adolescent; Adult; Aged; Amikacin; Bacteria; Bacterial Infections; Clavulanic Acids; Cross Infection; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; Hemorrhagic Disorders; Humans; Male; Middle Aged; Pancreatitis; Penicillin Resistance; Penicillins; Ticarcillin