netilmicin and Abscess

A case of retroperitoneal pulmonary fistula caused by a neonatal adrenal abscess is reported. The adrenal abscess was diagnosed by means of needle aspiration which guided the choice of antibiotic therapy. The fistula was demonstrated by direct injection of contrast medium into the adrenal abscess. Treatment by needle aspiration of the adrenal abscess and intravenous antibiotics was successful.

Topics: Abscess; Adrenal Gland Diseases; Anti-Bacterial Agents; Bronchial Fistula; Cefotaxime; Cephalosporins; Contrast Media; Escherichia coli Infections; Fistula; Gentamicins; Humans; Infant, Newborn; Injections, Intravenous; Lung Diseases; Male; Needles; Netilmicin; Suction; Tomography, X-Ray Computed

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.

Topics: Abscess; Adult; Cefotaxime; Diplopia; Drug Therapy, Combination; Humans; Male; Metronidazole; Netilmicin; Pituitary Diseases; Sella Turcica; Tomography, X-Ray Computed

Left-sided endocarditis caused by Pseudomonas aeruginosa is frequently associated with failure of medical therapy in man. The efficacy of ciprofloxacin and netilmicin + azlocillin has been studied in 79 rabbits with aortic valve endocarditis caused by a serum-resistant strain of P. aeruginosa. Infected animals received either: no therapy; ciprofloxacin (80 mg/kg/day); or netilmicin (6.5 mg/kg/day) + azlocillin (400 mg/kg/day). Ciprofloxacin significantly lowered vegetation titers of P. aeruginosa at days 6 and 10 of therapy compared with netilmicin + azlocillin (P less than 0.001). Similarly, ciprofloxacin was significantly more effective in sterilizing vegetations (P less than 0.005), curing P. aeruginosa endocarditis (P less than 0.001), and preventing bacteriological relapse after discontinuing antibiotic therapy (P less than 0.005). Both antibiotic regimens were equally effective in sterilizing renal abscesses. Resistance to azlocillin was occasionally observed in vivo among P. aeruginosa isolates within cardiac vegetations during the second week of therapy, but not to ciprofloxacin or netilmicin.

Topics: Abscess; Animals; Anti-Infective Agents; Aortic Valve; Azlocillin; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Kidney Diseases; Microbial Sensitivity Tests; Netilmicin; Penicillin Resistance; Pseudomonas Infections; Quinolines; Rabbits