netilmicin and Streptococcal-Infections

A 2-week course of ceftriaxone (2 g) plus netilmicin (4 mg/kg), administered as one short daily iv infusion, was evaluated for the treatment of streptococcal endocarditis in an open multicenter study. Of the 52 patients, 31 were infected with viridans streptococci, 18 with Streptococcus bovis, two with Gemella morbillorum, and one with group C Streptococcus; 48 patients were assessable. Infection was cured in 42 cases, 35 treated medically and seven treated both medically and surgically. Five patients died without evidence of active infection, and one relapsed. The bacteriologic failure was due to a strain of G. morbillorum against which no synergy of ceftriaxone and netilmicin was evident in vitro. The serum creatinine level increased during treatment in four cases, all involving patients > 65 years old who had renal risk factors; in two of these cases, values did not return to baseline during follow-up. Of 40 patients assessed for auditory function, only one developed decreased perception of borderline significance. Other adverse reactions were mild. This regimen was efficacious, safe, and cost-effective for the treatment of streptococcal endocarditis. However, it must be used with caution for patients with preexisting renal impairment or concomitant exposure to other potentially nephrotoxic agents.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Male; Middle Aged; Netilmicin; Prospective Studies; Streptococcal Infections; Treatment Outcome

Topics: Amikacin; Anti-Bacterial Agents; Drug and Narcotic Control; Humans; Infant, Newborn; Medical Audit; Netilmicin; New Zealand; Retrospective Studies; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptococcus agalactiae; Treatment Failure

Once-daily administration of aminoglycoside antibiotics has become the most acceptable dosing schedule for the majority of patients. There are few published data on the impact of post-natal age on aminoglycoside concentrations in preterm infants receiving once-daily dosage regimens. Netilmicin was administered as a once-daily dose of 4 mg/kg. In 141 episodes of suspected sepsis in 123 babies, trough netilmicin concentrations ranged from undetectable to 4.0 mg/l. Netilmicin concentrations were above a level of 2 mg/l in 10.6% of episodes. Netilmicin concentrations decreased with increasing post-natal age and weight. Levels were higher in males compared to females. Increased creatinine concentrations were associated with higher netilmicin concentrations. This study emphasises the importance of post-natal age as a determinant of aminoglycoside concentrations with a once-daily dosing regimen in a neonatal intensive care population. Trough levels should be carefully monitored and consideration given to extending dosage intervals particularly when netilmicin is administered once daily to preterm infants in the first week of life.

Topics: Aging; Anti-Bacterial Agents; Audiology; Body Weight; Creatinine; Enterobacteriaceae Infections; Enterococcus; Escherichia coli Infections; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intensive Care, Neonatal; Linear Models; Male; Netilmicin; Retrospective Studies; Sepsis; Staphylococcal Infections; Streptococcal Infections

Cardiac myxomas are rare tumors which may present differently. Left atrial myxoma is an entity from anatomopathological and clinical aspects. To the best of our knowledge, only 2 cases of infected left atrial myxomas treated surgically have been reported in the last 6 years. Herein, we present a patient with a left atrial myxoma prolapsing into the left ventricle in the diastolic phase, which was infected with Streptococcus viridans. Combined therapy, consisting of surgical management and antimicrobial therapy, was used. Clinical presentation, diagnosis and treatment are reviewed.

Topics: Anti-Bacterial Agents; Cefepime; Ceftazidime; Cephalosporins; Cloxacillin; Combined Modality Therapy; Diagnosis, Differential; Echocardiography, Transesophageal; Gentamicins; Heart Atria; Heart Neoplasms; Heart Ventricles; Humans; Male; Middle Aged; Myxoma; Netilmicin; Streptococcal Infections; Teicoplanin; Treatment Outcome; Vancomycin; Viridans Streptococci

A full-term infant was born with a swollen left conjunctival sac. Ophthalmia neonatorum developed within 5 d after birth. Examination of the purulent discharge showed Group B Streptococcus. The CRP level was found to be elevated and parenteral and topical therapy was started. Ophthalmia neonatorum resolved after 7 d of treatment.

Topics: Anti-Infective Agents, Local; Cefuroxime; Female; Humans; Infant, Newborn; Netilmicin; Ophthalmia Neonatorum; Pregnancy; Streptococcal Infections; Streptococcus agalactiae

To assess the efficacy and pitfalls of a protocol of generalized screening for group B Streptococcus (GBS) and intra-partum treatment of all carriers in a clinical setting.. A descriptive study and comparison with an historical group.. A tertiary perinatal center.. All women attending prenatal care in our center and delivered after 37 weeks were eligible. Study period ranged from January 1994 to September 1996. Comparison group consisted in deliveries of years 1992 and 1993.. Vaginal cultures were performed at 36 weeks on non-selective medium followed by intra-partum treatment of all carrier mothers. Rate of carriage, incidence of neonatal GBS sepsis, influence of risk factors and the reasons for failures were analysed. Comparison was made with an historical group. Statistical analysis was performed using a Chi-square test.. There were 5374 term deliveries during the study. 3906 were screened (72.7%) and 559 of them found positive for GBS (14.3%). We observed 46 early-onset GBS diseases (0.86% of term-births). 43.5% of infections occurred in babies born from mothers without risks factors at delivery. Negative GBS cultures at sampling accounted for 43.5% of protocol failures. Comparison of the incidence of early-onset GBS disease with the previous two years showed a significant drop (1.45-0.86%, P<0.05).. Our protocol revealed feasible and effective in reducing the incidence of early-onset GBS disease. Improvements must be studied particularly as to the predictive value of screening cultures.

Topics: Amoxicillin; Anti-Bacterial Agents; Carrier State; Female; Gentamicins; Gestational Age; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Netilmicin; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Streptococcal Infections; Streptococcus agalactiae; Vagina

Topics: Adult; Amoxicillin; Diagnosis, Differential; Endocarditis, Bacterial; Gentamicins; Humans; Male; Netilmicin; Osteoarthropathy, Secondary Hypertrophic; Penicillins; Streptococcal Infections; Streptococcus sanguis; Time Factors

We performed experiments in rats aimed at determining whether a combination of ceftriaxone (CRO) and netilmicin (NET), by using once-daily administration in rats, which simulated profiles of drug in human serum, was more effective than either agent alone in the treatment of endocarditis caused by viridans group streptococci. A programmable infusion pump system enabled the production of profiles of CRO in serum that simulate those found in humans after the intravenous administration of 2 g. The subcutaneous administration of 18 mg of NET per kg of body weight produced levels in the sera of rats comparable to those after the intravenous administration of a dose of 5 mg of NET per kg in humans. Rats with catheter-induced aortic vegetations were infected intravenously with two test strains, a CRO-susceptible Streptococcus sanguis strain (MICs of CRO and NET, 0.064 and 8 mg/liter, respectively) and a relatively CRO-resistant Streptococcus mitis strain (MICs of CRO and NET, 2 and 8 mg/liter, respectively). Against both strains, the combination of CRO and NET was synergistic in vitro as determined by time-kill curves. Treatment of rats was started 48 h postinfection and lasted for 3 days. CRO alone was effective against the susceptible strain (P < 0.001 compared with control animals) but was not effective against the resistant organism. A significantly enhanced antibacterial activity of the CRO-NET combination in reducing the valvular bacterial counts was observed with both test strains (P < 0.001). The synergistic effect was obtained with a single daily injection of NET which provided detectable levels in serum for only 8 h, suggesting that in vivo synergism in the treatment of infections caused by viridans group streptococci can be obtained without 24 h of aminoglycoside coverage. These experimental data might provide a rationale for clinical trials of a once-a-day dosing regimen in the treatment of streptococcal but nonenterococcal endocarditis.

Topics: Animals; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Infusion Pumps; Microbial Sensitivity Tests; Netilmicin; Rats; Rats, Wistar; Serum Bactericidal Test; Streptococcal Infections; Streptococcus; Streptococcus sanguis

We have conducted experiments to determine if one daily injection of netilmicin (NET) would be synergistic with the broad-spectrum cephalosporin ceftriaxone (CRO) in the treatment of experimentally induced endocarditis. Rats with catheter-induced aortic vegetations were infected intravenously with 3 x 10(7) CFU of a beta-lactam-sensitive strain of Streptococcus sanguis or a beta-lactam-resistant strain of Streptococcus mitis. Treatment with the antibiotics alone (CRO, 10 mg/kg of body weight every 8 h; NET, 18 mg/kg every 24 h) or in combinations which had proved synergistic in in vitro time-kill curves was commenced 48 h postinfection and continued for 72 h. The results show that the combination was markedly effective against S. sanguis and moderately effective against S. mitis, while, with the protocol used here, the agents alone were not. The results suggest that CRO-NET should be an effective combination for treating streptococcal endocarditis in humans and may permit a shorter duration of treatment and once-a-day dosing to be used.

Topics: Animals; Ceftriaxone; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Netilmicin; Rats; Rats, Wistar; Serum Bactericidal Test; Streptococcal Infections; Streptococcus; Streptococcus sanguis

Group B streptococcus (GBS) is an important cause of neonatal infection. Early-onset diseases are due to perinatal contamination. The epidemiology of late-onset infections is poorly known. Maternal colonization may be responsible for some of them. The relationships between neonatal colonization and late disease could be a colonization of the gut. The purpose of this 3 year-prospective study was to analyse the kinetics of gut colonization in neonates and the influence of antibiotherapy. One hundred and nineteen infants less than one month of age were included because of the presence of GBS in their gastric aspirates or GBS infection. Depending on the therapeutic strategy, the infants were separated into 3 groups: 1) amoxicillin plus aminoside greater than or equal to 10 days because of neonatal infection (28 infants), 2) same combination less than or equal to 5 days because a GBS infection was suspected but not confirmed (17 infants), 3) no antibiotics (77 infants). Fecal flora was regularly analysed by differential count. Antibiotics caused rapid disappearance of GBS from the gut. However, the same strain reappeared after stopping the antibiotics at a rate of 13.5%. Without antibiotics, GBS was implanted in 33% of cases. This difference of implantation rate is statistically significant (p less than 0.05). No GBS infection was observed in any infant after a follow-up examination of 6 months to 2 years. Among the clinical and bacteriological factors studied, adhesion only was correlated with the GBS implantation. These results allow to discuss therapeutic abstention in colonized infants without any signs of infection.

Topics: Ampicillin; Cohort Studies; Digestive System Diseases; Drug Combinations; Follow-Up Studies; France; Humans; Infant, Newborn; Netilmicin; Prospective Studies; Streptococcal Infections; Streptococcus agalactiae

Thrombotic obstruction is rare in bacterial endocarditis involving prosthetic heart valves. A 45-year-old man who had three intracardiac, ball-cage-type prosthetic valves, presented with streptococcal septicemia. Major obstruction of the tricuspid Smeloff-Cutter valve and normal function of the two other prostheses were documented by Doppler echocardiography. Emergency replacement of the tricuspid valve alone was decided on the one basis of this echocardiographic diagnosis, and successfully performed. Operative findings confirmed the noninvasive findings.

Topics: Ampicillin; Aortic Valve; Bioprosthesis; Combined Modality Therapy; Echocardiography, Doppler; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Netilmicin; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Rheumatic Heart Disease; Streptococcal Infections; Tricuspid Valve

Topics: Ampicillin; Drug Resistance, Microbial; Drug Therapy, Combination; Enterococcus faecalis; Humans; Infant; Male; Netilmicin; Sepsis; Streptococcal Infections; Vancomycin

Topics: Aged; Cephalothin; Child; Drug Antagonism; Endocarditis, Bacterial; Floxacillin; Fusidic Acid; Gentamicins; Humans; Male; Netilmicin; Staphylococcal Infections; Streptococcal Infections

30 urological patients with normal renal function were treated with netilmicin because of urinary tract infections, mostly recurrent and due to predisposing factors. the drug was given in doses of 4 mg/kg/day for 4-9 days. All but 5 patients had resolution of their signs and symptoms, and the bacteria were eliminated in 23 patients, with recurrence in 8 and reinfection in 3. The bacteria persisted in 1 patient and the results were indeterminate in 6 patients. No signs of hematopoietic, renal and hepatic toxicity occurred, and vestibular and auditory functions were undisturbed. Regular assays of serum drug concentrations revealed no signs of accumulation. Netilmicin given in doses of 4 mg/kg/day is an efficient antibiotic with low toxicity in the treatment of urinary tract infections.

Topics: Adolescent; Adult; Aged; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections

Thirty neonates and infants have been treated for verified or suspected infections with a combination of netilmicin and ampicillin intravenously for 7 days. The infecting organisms were isolated in 18 patients, of whom 2 had osteomyelitis and 2 had pneumonia. In 3 cases of pneumonia and 9 cases of suspected septicaemia bacteriological cultures were negative. None of the children died, and in all but the 2 cases of osteomyelitis, therapy led to complete resolution of the signs of infection and recovery without sequelae. No adverse reactions to antibiotic therapy were recorded. Upon follow-up examinations at the age of 3 months there has been no sign of auditory impairment as assessed by Brain Stem Evoked Response. Netilmicin is thus tolerated well in neonates and infants, and when guided by serum concentrations considered to be a safe and reliable aminoglycoside.

Topics: Drug Evaluation; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Netilmicin; Osteomyelitis; Sepsis; Staphylococcal Infections; Streptococcal Infections

38 newborn infants, 28 males and 10 females, were treated with netilmicin in doses 6-7 mg/kg/day for suspected or verified infections. 19 patients were mature (mean birth weight 3169 g) and 19 were premature (mean birth weight 1864 g). 32 had moderate or severe underlying diseases. 37 babies survived, 33 were cured or improved markedly and in 4 the results were indeterminate. Pathogenic bacteria were demonstrated in 24 cases and were eliminated in 15. Only one baby died. He suffered from severe respiratory distress syndrome and Escherichia coli septicemia. No E. coli was isolated at autopsy. The mean netilmicin peak serum value was 7.7 micrograms/ml (range 1.0-30.0) and the mean trough concentration 2.1 micrograms/ml (range 0.0-9.2). No adverse effects were seen.

Topics: Bacterial Infections; Drug Evaluation; Enterobacteriaceae Infections; Female; Gentamicins; Haemophilus Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Netilmicin; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

49 newborns and infants were treated with netilmicin for verified or suspected infections. Infection was verified in 23 patients (mean gestational age 32 weeks and mean body weight 2100 g) and clinical cure or marked improvement occurred in 20 of these. Of the remaining 3 patients, 2 died, partly due to reasons unassociated with infection. 25 causative organisms were isolated and bacteriological elimination was achieved in 73% of the cases. At an average dose of 2.6 mg/kg twice a day, peak serum concentrations (30 min following injection) were 7.4 +/- 3.4 micrograms/ml. Serum half life was approximately 4.5 hours for infants born at term, and longer at shorter gestational age. Netilmicin is considered a safe and efficient aminoglycoside with a low rate of adverse effects.

Topics: Bacterial Infections; Drug Evaluation; Escherichia coli Infections; Female; Gentamicins; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Klebsiella Infections; Male; Netilmicin; Sepsis; Staphylococcal Infections; Streptococcal Infections

The combination of penicillin plus netilmicin was synergistic in vitro against 28 strains of Streptococcus faecalis and compared favorably with penicillin in combination with gentamicin. Similarly, penicillin plus netilmicin was as effective as penicillin plus gentamicin in the therapy of 67 rabbits with enterococcal endocarditis produced with a streptomycin-susceptible (S) or a streptomycin-resistant (R) strain of S. faecalis. After 5 days of infection, control rabbits had bacterial titers of 10(10) colony-forming units (CFU)/g of vegetation. Those treated with penicillin plus netilmicin had mean titers of 10(5.2) and 10(5.1) CFU/g for S and R strains, respectively, and those treated with penicillin plus gentamicin had mean valve titers of 10(5.8) CFU/g for both strains. After 10 days of therapy, mean valve titers with penicillin plus netilmicin were 10(3.8) and 10(4.7) CFU/g, and with penicillin plus gentamicin they were 10(4.5) and 10(5.4) CFU/g for S and R strains, respectively. Thus, if netilmicin proves to be less toxic than other aminoglycoside antibiotics, it may have potential usefulness in the therapy of enterococcal endocarditis.

Topics: Animals; Drug Synergism; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Humans; Microbial Sensitivity Tests; Netilmicin; Penicillins; Rabbits; Streptococcal Infections

Successful therapy of enterococcal endocarditis requires the use of a combination of penicillin plus an aminoglycoside. The effectiveness of penicillin (Pen), streptomycin (Str), and netilmicin (Net), a new aminoglycoside, alone and in combination, were studied in vitro and in the treatment of left-sided enterococcal endocarditis in rabbits. In vitro Pen+Str or Net resulted in a more rapid and more complete bactericidal effect than Pen, Str, or Net alone against a Str-susceptible strain of enterococcus (strain 1). Against a highly Str-resistant strain (strain 2), Pen+Net showed an advantage over Pen, Str, or Net alone, or Pen+Str. Endocarditis was produced in rabbits with strain 1 or 2, and treatment was initiated 24 h later. Rabbits were treated for 48 h or 5 days with procaine Pen, Pen+Str, or Pen+Net. With strain 1, numbers of enterococci in the vegetations decreased more rapidly with Pen+Str or Pen+Net treatment than with Pen, Str, or Net alone. With strain 2, Pen+Net showed a clear advantage over Pen, Str, Net, or Pen+Str. Net in combination with Pen showed synergistic in vitro activity and was more effective than Pen alone in the treatment of enterococcal endocarditis in rabbits caused by both Str-susceptible and Str-resistant strains.

Topics: Animals; Drug Therapy, Combination; Endocarditis, Bacterial; Enterobacteriaceae Infections; Enterococcus faecalis; Female; Netilmicin; Penicillin Resistance; Penicillins; Rabbits; Streptococcal Infections; Streptomycin