colistin and Acute-Disease

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Topics: Acute Disease; Anti-Bacterial Agents; Ciprofloxacin; Colistin; Drug Therapy, Combination; Humans; Infection Control; Infections; Leukemia; Multicenter Studies as Topic; Neutropenia; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Environment, Controlled; Gentamicins; Humans; Leukemia; Neoplasms; Nystatin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Patients with cystic fibrosis have received more intravenous antibiotic courses as median survival has steadily increased. A number of centres have adopted a policy of regular (three monthly) rather than on demand intravenous antipseudomonal antibiotics. More widespread bacterial antibiotic resistance has resulted from this increased antibiotic use. Most Pseudomonas aeruginosa strains remain fully sensitive to colistin but its use has been resisted owing to concerns about neurotoxicity and nephrotoxicity. A study was carried out to assess the safety and efficacy of intravenous colistin in the treatment of acute respiratory exacerbations in adult patients with cystic fibrosis.. Patients with chronic Pseudomonas aeruginosa colonisation who presented with protocol defined respiratory tract exacerbations were randomised to receive treatment for 12 days with either colistin (2 MU tds intravenously) alone or with a second anti-pseudomonal antibiotic. Comparisons of the absolute values of respiratory function tests on days 1, 5, and 12 and of overnight oxygen saturation on days 1 and 12 were the primary outcome measures. Patient's weight, clinical and chest radiographic scores, and peripheral blood markers of inflammation were also documented. The effect of each treatment regimen individually was assessed by the change in clinical measurements from baseline values. Adverse renal effects were monitored by measurement of serum levels of urea and electrolytes, creatinine clearance, and ward urine testing. Neurotoxicity was monitored by direct questioning for symptoms.. Fifty three patients, 18 of whom entered the study twice, were enrolled. The mean forced expiratory volume in one second (FEV1) increased significantly in both groups, mean forced vital capacity (FVC) only with dual therapy. Both groups showed a non-significant increase in overnight oxygen saturation. All patients showed clinical improvement. Thirty seven adverse neurological events (two severe) were reported in 33 patients in the monotherapy group and 37 (none severe) in 36 patients in the dual therapy group. One patient withdrew because of severe weakness and dizziness. All other adverse neurological events were well tolerated and resolved during or shortly after treatment. Significant changes were seen in mean serum urea levels in both groups, but in only four patients to a level above the normal range, and in creatinine clearance in the dual therapy group. At 24 month follow up no long term adverse consequences from intravenous colistin were found in patients who completed the study.. Intravenous colistin is an effective treatment for Pseudomonas aeruginosa associated pulmonary exacerbations in patients with cystic fibrosis. Assessment of the individual effect of each treatment regimen suggests a greater efficacy when colistin is combined with a second antibiotic to which the pseudomonas shows in vitro sensitivity. Changes in renal function should be monitored.

Topics: Acute Disease; Adult; Analysis of Variance; Anti-Bacterial Agents; Colistin; Creatinine; Cystic Fibrosis; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Kidney; Male; Pseudomonas Infections; Statistics, Nonparametric; Urea

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Topics: Acute Disease; Anti-Bacterial Agents; Ciprofloxacin; Colistin; Drug Therapy, Combination; Humans; Infection Control; Infections; Leukemia; Multicenter Studies as Topic; Neutropenia; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

Pipemidic acid (PPA) and colistin sodium methanesulfonate (CLM) may selectively suppress aerobic gram-negative bacilli. Twenty-nine patients with acute leukemia were randomized after each course of consolidation chemotherapy to receive a single agent of nystatin (NYS) (34 courses) versus a combination of NYS, PPA and CLM (36 courses). The duration of fever over 39 degrees C was longer with the three drug combination (4.6 +/- 5.1 days) than with NYS alone (1.8 +/- 1.8 days) (P less than 0.01). Four cases of pneumonia occurred and four patients including one having pneumonia died of infection with the three drug combination, while no pneumonia or death occurred with NYS alone (P = 0.06 and P = 0.06, respectively). The combination of NYS, PPA and CLM may be less effective than NYS alone for the prevention of infection in acute leukemia patients with chemotherapy-associated granulocytopenia.

Topics: Acute Disease; Adolescent; Adult; Agranulocytosis; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Colistin; Drug Therapy, Combination; Gram-Negative Bacteria; Humans; Leukemia; Middle Aged; Nicotinic Acids; Nystatin; Pipemidic Acid; Pneumonia; Random Allocation

An open, prospective, randomised, comparative study of "Trisdine" and kanamycin-colistin bladder instillations in reducing significant bacteriuria during intermittent urethral catheterisation was conducted. Trisdine is an aqueous solution of chlorhexidine gluconate 0.01% with added ethylenediaminetetra-acetic acid disodium salt and TRIS buffer at final concentrations of 1.34 mMoles and 0.01 Molar respectively. All patients (15 males and 3 females) admitted with acute spinal cord trauma and bladder involvement requiring intermittent catheterisation for more than 5 days during a 12-month period were studied. There was no significant difference in the mean incidence of significant bacteriuria during intermittent catheterisation in the 7 males who had kanamycin-colistin bladder instillations compared with the 8 males who had Trisdine instillations. A comparison could not be made in the females because there were only 3 patients. Because Trisdine is more stable at ambient temperatures, is less likely to select antibiotic-resistant bacteria and is less expensive, it is concluded that Trisdine is preferable to kanamycin-colistin solution for bladder instillations during intermittent catheterisation.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Bacteriuria; Chlorhexidine; Clinical Trials as Topic; Colistin; Drug Combinations; Edetic Acid; Female; Humans; Kanamycin; Male; Middle Aged; Prospective Studies; Random Allocation; Spinal Cord Injuries; Tromethamine; Urinary Catheterization

Topics: Acute Disease; Adult; Anti-Infective Agents; Ciprofloxacin; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Humans; Infection Control; Leukemia; Neomycin; Neutropenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty-six patients receiving remission induction treatment for acute leukemia were studied in a randomized trial comparing ciprofloxacin with trimethoprim-sulfamethoxazole plus colistin for prevention of infections. Both groups received amphotericin B for antifungal prophylaxis. Six major infections occurred in 28 patients receiving ciprofloxacin, and 11 major infections occurred in 28 patients receiving trimethoprim-sulfamethoxazole plus colistin. No infections caused by gram-negative bacilli were seen in the ciprofloxacin group (p less than 0.02). Ciprofloxacin prevented colonization with resistant gram-negative bacilli, but 12 resistant colonizing strains were isolated from 10 patients receiving trimethoprim-sulfamethoxazole plus colistin (p less than 0.01). Ciprofloxacin was better tolerated: 23 of 28 patients were highly compliant to the drug, compared with 15 of 28 patients in the trimethoprim-sulfamethoxazole group (p less than 0.05). These results suggest that ciprofloxacin is a promising drug for the prevention of infection in patients with granulocytopenia.

Topics: Acute Disease; Agranulocytosis; Bacterial Infections; Ciprofloxacin; Colistin; Drug Combinations; Drug Resistance, Microbial; Humans; Leukemia; Leukemia, Lymphoid; Patient Compliance; Random Allocation; Sulfamethizole; Sulfathiazoles; Trimethoprim

Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Environment, Controlled; Gentamicins; Humans; Leukemia; Neoplasms; Nystatin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

43 patients undergoing treatment for acute leukaemia were randomised to receive either co-trimoxazole alone or co-trimoxazole with framycetin and colistin as antibacterial prophylaxis during periods of neutropenia. There were no significant differences between the two treatment groups in the time before the onset of the first fever, the number of episodes of fever or of septicaemia per patient, the number of neutropenic days during which patients remained afebrile or did not require systemic antibiotics, or the number of resistant organisms acquired. Co-trimoxazole alone is cheaper and easier to take than co-trimoxazole with framycetin and colistin, and it is therefore preferable to the three-drug combination for the prophylaxis of bacterial infection.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Female; Framycetin; Humans; Leukemia; Male; Middle Aged; Neutropenia; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Bacterial Agents; Bone Marrow Transplantation; Clinical Trials as Topic; Colistin; Drug Combinations; Humans; Infection Control; Leukemia, Myeloid; Mycoses; Neomycin; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

113 patients being treated for acute non-lymphoblastic leukaemia were investigated to determine the effect of suppression of body microbial flora on prevention of infection. They were randomly allocated to a control group or a group which received non-absorbed antibiotics by mouth and topical applications of cutaneous and mucosal antiseptic preparations. The group receiving oral non-absorbed antibiotics had significantly few infections, fewer deaths from infection, fewer pyrexial episodes, and consequently received less systemic antibiotic therapy than the controls.

Topics: Acute Disease; Administration, Oral; Administration, Topical; Adolescent; Adult; Antineoplastic Agents; Bacterial Infections; Bacteroides Infections; Chlorhexidine; Colistin; Drug Combinations; Enterobacteriaceae Infections; Framycetin; Humans; Leukemia; Nystatin; Remission, Spontaneous; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections

Escherichia coli isolates carrying the mcr-1 gene are rarely reported in diarrhoeal patients. Here we report the draft genome sequence of a colistin-resistant E. coli isolated from a hospitalised patient with acute diarrhoea in Thailand.. Whole genomic DNA of the colistin-resistant E. coli isolate (MSF11) was extracted and was sequenced using an Ion Torrent sequencer with 400-bp read chemistry. The draft genome sequence of MSF11 was analysed with regard to multilocus sequence type (ST), serotype, acquired antimicrobial resistance genes, plasmid replicon types and virulence genes using tools from the Center for Genomic Epidemiology.. E. coli strain MSF11 was serotype OUT:H10 and ST226. Acquired antimicrobial resistance genes [bla. An mcr-1 variant was identified in an E. coli isolate harbouring the EAST1 (enteroaggregative E. coli heat-stable toxin 1) gene (astA) from a human diarrhoeal stool specimen. This study highlights the potential risk of dissemination of colistin-resistant E. coli in view of the prevalence of the variant gene on IncX4-type plasmids.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Typing Techniques; Colistin; Diarrhea; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Genetic Variation; Genome, Bacterial; Humans; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Plasmids; Thailand; Whole Genome Sequencing

Topics: Acute Disease; Anti-Bacterial Agents; Child; Colistin; Drug Administration Schedule; Humans; Male; Metabolic Clearance Rate; Osteomyelitis; Practice Guidelines as Topic; Pseudomonas aeruginosa; Pseudomonas Infections

Topics: Acute Disease; Anti-Bacterial Agents; Colistin; Diarrhea; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans

Colistin resistance mediated by the mcr-1 gene has been reported worldwide, but to date not from the Andean region, South America. We report the first clinical isolate of Escherichia coli harbouring the mcr-1 gene in Ecuador. The strain was isolated from peritoneal fluid from a 14-year-old male with acute appendicitis, and subjected to molecular analysis. The minimum inhibitory concentration of colistin for the strain was 8 mg/ml and it was susceptible to carbapenems but resistant to tigecycline. The strain harboured mcr-1 and bla CTX-M-55 genes and was of sequence type 609. The recognition of an apparently commensal strain of E. coli harbouring mcr-1 serves as an alert to the presence in the region of this recently described resistance mechanism to one of the last line of drugs available for the treatment of multi-resistant Gram-negative infections.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Appendicitis; Colistin; Drug Resistance, Bacterial; Ecuador; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Male; Microbial Sensitivity Tests

The identification of the optimal agent for administration via the respiratory tract when treating pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB).. A murine model of acute CRAB pneumonia was established by intratracheal (i.t.) inoculation with 2.5 × 10⁷ colony-forming units (CFU) of A. baumannii strain Ab396 plus 10% porcine mucin. After 4h the infected BALB/c mice were treated intratracheally with 25μl of either 0.85% saline (control group), colistimethate sodium (CMS) (166 666 U/kg, CMS group), imipenem/cilastatin (30/30 mg/kg, imipenem group), or meropenem (20mg/kg, meropenem group), every 8h. The therapeutic efficacy of these agents was examined.. A. baumannii strain Ab396 was susceptible to CMS only. However, meropenem treatment did give a significantly superior survival rate (100%) compared to treatment with imipenem (50%), CMS (33%), or saline (0%) (p<0.001 vs. the control and CMS groups, p=0.006 vs. the imipenem group, by log-rank test). Furthermore, compared to the other groups, the meropenem group demonstrated significantly more favorable results in terms of tissue penetration of the antibiotic, bacterial clearance, normalization of the wet lung-to-body weight ratio, and down-regulation of pro-inflammatory cytokine levels in the lungs.. Administration of meropenem via the respiratory tract proved to have the best therapeutic efficacy among the antibiotics tested when treating advanced murine CRAB pneumonia.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Acute Disease; Animals; Anti-Bacterial Agents; Carbapenems; Cilastatin; Cilastatin, Imipenem Drug Combination; Colistin; Cytokines; Disease Models, Animal; Drug Combinations; Drug Resistance, Bacterial; Female; Imipenem; Meropenem; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Pneumonia, Bacterial; Stem Cells; Thienamycins

Nosocomial infections due to MDR P. aeruginosa are an increasing problem. Therapeutical options are few. We describe two haematological patients with severe neutropenia and systemic infection due to MDR P. aeruginosa treated successfully with colistin plus ceftazidime. Severe adverse events were not described.

Topics: Acute Disease; Adrenal Cortex Hormones; Aged; Anemia, Refractory, with Excess of Blasts; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Ceftazidime; Colistin; Colitis; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Infusions, Intravenous; Leukemia, Myeloid; Lymphoma, Non-Hodgkin; Male; Middle Aged; Neoplasms, Second Primary; Peritonitis; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pseudomonas Infections; Radiation Injuries; Spinal Neoplasms; Typhlitis

An 8 year old girl with cystic fibrosis had severe respiratory disease associated with chronic Pseudomonas aeruginosa bronchopulmonary infection. Despite regular courses of intravenous antipseudomonal antibiotics, she continued to deteriorate over 18 months with persistent productive cough, worsening respiratory function, and increasing oxygen dependence. During her 11th admission Streptococcus milleri was isolated from sputum cultures in addition to P aeruginosa. She failed to respond to antipseudomonal antibiotics but improved dramatically with the addition of intravenous benzylpenicillin. Although S milleri is considered a normal mouth commensal and its isolation from sputum of cystic fibrosis patients is of uncertain significance, it was associated with clinically significant infection in this child. S milleri was eradicated with antibiotic treatment and clinical improvement has been maintained.

Topics: Acute Disease; Child; Colistin; Cystic Fibrosis; Drug Therapy, Combination; Female; Floxacillin; Humans; Metronidazole; Penicillin G; Pseudomonas Infections; Sputum; Streptococcal Infections; Streptococcus

The authors test antibiotic strategies aimed at either mitigating bacterial translocation from the gut or delivering antibiotics specifically concentrated by the pancreas for prevention of early secondary infection after acute necrotizing pancreatitis.. Infection currently is the principal cause of death after severe pancreatitis. The authors have shown that the risk of bacterial infection correlates directly with the degree of tissue injury in a rodent model of pancreatitis. Bacteria most likely arrive by translocation from the colon.. Severe acute necrotizing pancreatitis was induced in rats by a combination of low-dose controlled intraductal infusion of glycodeoxycholic acid superimposed on intravenous cerulein hyperstimulation. At 6 hours, animals were randomly allocated to five treatment groups: controls, selective gut decontamination (oral antibiotics and cefotaxime), oral antibiotics alone, cefotaxime alone, or imipenem. At 96 hours, surviving animals were killed for quantitative bacterial study of the cecum, pancreas, and kidney.. The 96-hour mortality (35%) was unaffected by any treatment regimen. Cecal gram-negative bacteria were significantly reduced only by the oral antibiotics. Pancreatic infection was significantly reduced by full-gut decontamination and by imipenem, but not by oral antibiotics or by cefotaxime alone. Renal infection was reduced by both intravenous antibiotics.. Early pancreatic infection after acute necrotizing pancreatitis can be reduced with a full-gut decontamination regimen or with an antibiotic concentrated by the pancreas (imipenem) but not by unconcentrated antibiotics of similar spectrum (cefotaxime) or by oral antibiotics alone. These findings suggest that 1) both direct bacterial translocation from the gut and hematogenous seeding interplay in pancreatic infection while hematogenous seeding is dominant at extrapancreatic sites and 2) imipenem may be useful in clinical pancreatitis.

Topics: Acute Disease; Administration, Oral; Amphotericin B; Animals; Bacteria; Bacterial Infections; Bacterial Physiological Phenomena; Cecal Diseases; Cefotaxime; Colistin; Disease Models, Animal; Drug Therapy, Combination; Imipenem; Injections, Intravenous; Kidney Diseases; Male; Necrosis; Pancreas; Pancreatic Diseases; Pancreatitis; Rats; Rats, Sprague-Dawley; Survival Rate; Tobramycin

A study was performed on 321 patients with paratrachoma: acute follicular conjunctivitis-189, subacute-132. The first group of patients (108) received 1% Tetracycline ointment 4 to 5 times daily, the second group (103 patients)-1% Tetracycline ointment + 0.1% Dexamethasone eye drops, the third group (110 patients)-Eubetal ointment (tetracycline 0.5%, betamethasone 0.1%, chloramphenicol 1%, colistin). Therapeutic efficacy was higher in groups were antibiotics combined with corticosteroids. Cured in 4 weeks in group I-46.3%, in group II-72.8%, in group III-71.8%, cured in 6 weeks-75.9%, 88.3% and 86.4% respectively.

Topics: Acute Disease; Administration, Topical; Adolescent; Adult; Betamethasone; Chlamydia Infections; Chloramphenicol; Colistin; Conjunctivitis, Inclusion; Dexamethasone; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Ointments; Ophthalmic Solutions; Tetracycline; Treatment Outcome; Urethritis; Uterine Cervicitis

In a Tunisian hospital 27 babies, including 12 who were premature, in a single intensive care unit suffered acute gastroenteritis in the period from January to May 1988. The mean age at the onset of gastroenteritis was 8.4 days; nine babies died. Salmonella wien was isolated from stools (all babies) and blood (4 babies). It was also isolated from the stools of one nurse and from a mattress. Twelve of the babies had received cefotaxime, which was successfully replaced by oral colimycin. The outbreak was stopped by the implementation of infection control measures. All isolates of Salmonella wien were of the same biotype, and had the same antibiotic resistance pattern (third generation cephalosporins, monobactams, aminoglycosides, chloramphenicol, trimethoprim and sulphonamides) and plasmid DNA restriction pattern. The isolates were all susceptible to a combination of cefotaxime and clavulanic acid (a beta-lactamase inhibitor), which displayed synergy, suggesting the presence of a beta-lactamase (geometric mean MICs 11.24 micrograms/ml for cefotaxime alone and 0.24 micrograms/ml in combination with 0.1 micrograms/ml potassium clavulanate). All isolates produced TEM-1 and SHV-2 beta-lactamase which was not transferable to Escherichia coli by conjugation. The presence of the SHV-2 enzyme in Salmonella wien may allow it to adapt to newer beta-lactams which is a cause for concern in this hospital.

Topics: Acute Disease; beta-Lactamases; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Colistin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Drug Synergism; Feces; Gastroenteritis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Salmonella; Salmonella Infections; Tunisia

Topics: Acute Disease; Bacterial Infections; Colistin; Drug Evaluation; Drug Therapy, Combination; Framycetin; Humans; Leukemia; Neomycin; Nystatin; Patient Isolation

Two groups of patients with acute spinal cord trauma had initial bladder management by standard non-touch techniques of intermittent catheterisation. Twenty-two patients (17 males and 5 females) had kanamycin-colistin solution instilled into the bladder at the end of each catheterisation, and 25 patients (21 males and 4 females) were not given these instillations. The incidence of significant bacteriuria during intermittent catheterisation of both males and females receiving the instillations was only half the incidence of those not receiving the instillations. Also, a significantly higher proportion of males receiving the instillations did not have any episodes of significant bacteriuria compared with those not receiving the instillations, and the same trend was evident in the small number of female patients. It is recommended that patients should have kanamycin-colistin bladder instillations when they are being intermittently catheterised.

Topics: Acute Disease; Bacteria; Bacteriuria; Colistin; Drug Combinations; Female; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Solutions; Spinal Cord Injuries; Urinary Bladder; Urinary Catheterization

Topics: Acute Disease; Antidiarrheals; Colistin; Diarrhea, Infantile; Drug Evaluation; Humans; Infant

The therapeutic potencies of colistin methanesulfonate (CLM) was assessed quantitatively in acute infection of mice with clinically isolated strains of Escherichia coli and Pseudomonas aeruginosa, and effect of different routes of administration was compared. There was no detectable difference in the therapeutic effect of CLM when intramuscular (im) or intravenous (iv) administration was initiated one hour after the infection. On the other hand, a significant difference in ED50 given by im and iv administrations was observed, indicating the superiority of iv administration, when the treatment started 4 to approximately hours after the infection. No difference in the therapeutic effect of polymyxin B (PMB) and tetracycline (TC) administered via either im or iv route was found even in the delayed administration. In contrast to PMB and TC, lower toxicity of CLM was determined when it was administered iv rather than im.

Topics: Acute Disease; Animals; Bacterial Infections; Colistin; Escherichia coli; Escherichia coli Infections; Female; Injections, Intramuscular; Injections, Intravenous; Male; Mesylates; Mice; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Tetracycline

Topics: Acute Disease; Anti-Bacterial Agents; Bone Diseases; Clindamycin; Colistin; Colitis; Drug Combinations; Drug Hypersensitivity; Humans; Neomycin; Sulfamethoxazole; Trimethoprim

Topics: Acute Disease; Child; Child, Preschool; Chloramphenicol; Colistin; Female; Follow-Up Studies; gamma-Globulins; Glucocorticoids; Humans; Infant; Infant, Newborn; Male; Meningitis; Penicillin G; Sulfonamides; Suppuration

Topics: Acute Disease; Age Factors; Ampicillin; Anti-Bacterial Agents; Child, Preschool; Chloramphenicol; Colistin; Erythromycin; Haemophilus; Haemophilus Infections; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Otitis Media; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes; Streptomycin; Tetracycline

Topics: Acute Disease; Anti-Bacterial Agents; Chloramphenicol; Cholecystitis; Chronic Disease; Colistin; Escherichia coli Infections; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin

Topics: Acute Disease; Animals; Colistin; Kidney; Kidney Diseases; Male; Mannitol; Potentiometry; Rabbits

Topics: Acute Disease; Ampicillin; Anemia, Aplastic; Blood Transfusion; Child; Child, Preschool; Chloramphenicol; Colistin; Diet Therapy; Female; Fructose; Hemostatics; Hepatitis A; Humans; Male; Methandrostenolone; Methylprednisolone; Oxacillin; Paromomycin; Prednisone

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Antitoxins; Chloramphenicol; Colistin; Drug Synergism; gamma-Globulins; Mice; Oleandomycin; Oxacillin; Penicillin Resistance; Penicillins; Staphylococcal Infections; Tetracycline; Time Factors

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Appendicitis; Child; Child, Preschool; Colistin; Female; Humans; Male; Methods; Middle Aged; Peritoneal Diseases; Rolitetracycline; Time Factors

Topics: Acute Disease; Colistin; Humans; Pseudomonas Infections; Urinary Tract Infections

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Colistin; Dogs; Erythromycin; Female; Kanamycin; Kidney; Lincomycin; Liver; Pancreas; Pancreatic Juice; Pancreatitis; Staphylococcus; Tetracycline; Toxins, Biological

Topics: Acute Disease; Anti-Bacterial Agents; Appendicitis; Child; Colistin; Humans; Infant; Peritonitis; Urinary Tract

Topics: Acute Disease; Anti-Bacterial Agents; Appendicitis; Appendix; Colistin; Humans