piperacillin--tazobactam-drug-combination and Pleural-Effusion

Evidence from a recent randomized study of our group suggests that intravenous clarithromycin resulted in earlier resolution of ventilator-associated pneumonia. The need to understand the mechanism of action of clarithromycin guided to the study of a model of experimental empyema by multidrug-resistant Pseudomonas aeruginosa in 40 rabbits. Animals were randomized into controls (group A); treatment with clarithromycin (group B); treatment with piperacillin/tazobactam (group C); and treatment with both agents (group D). Pleural fluid was collected at regular time intervals for quantitative culture, estimation of cell apoptosis and of concentrations of tumour necrosis factor-alpha (TNFα). After 7 days, animals were euthanized for estimation of tissue growth. Bacterial growth in the pleural fluid of group D was significantly decreased compared with the other groups on day 5. Lung growth of group D was lower than group A. That was also the case of cytokine stimulation by pleural fluid samples on U937 monocytes. It is concluded that administration of clarithromycin enhanced the antimicrobial efficacy of piperacillin/tazobactam and decreased bacterial growth in the pleural fluid and in tissues. It also attenuated the pro-inflammatory phenomena induced by the β-lactam.

Topics: Adjuvants, Immunologic; Animals; Anti-Bacterial Agents; Apoptosis; Clarithromycin; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Empyema, Pleural; Humans; Interleukin-6; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pleural Effusion; Pseudomonas aeruginosa; Pseudomonas Infections; Rabbits; Tumor Necrosis Factor-alpha; U937 Cells

Topics: Abscess; Anti-Bacterial Agents; Debridement; Diabetes Mellitus, Type 2; Disease Susceptibility; Empyema, Pleural; Hematoma; Humans; Male; Middle Aged; Obesity, Morbid; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pleural Effusion; Smoking; Streptococcal Infections; Streptococcus agalactiae; Thoracic Injuries; Wound Infection; Wounds, Nonpenetrating

Spontaneous oesophageal perforation or Boerhaave's syndrome is a life-threatening condition that usually requires early diagnosis and early surgical management. A 79-year-old man presented to the accident and emergency department with an ischaemic left big toe. He reported a 2-week history of worsening symptoms and a claudication distance in his left leg of 20-30 m. Three days post-revascularisation of the leg, the patient reported chest pain radiating to the back. CT angiography of the aorta indicated Boerhaave's syndrome. Following 35 days of conservative management in the intensive care unit and high dependency unit, the patient was stepped down to a surgical ward. A water-soluble contrast study demonstrated minimal leak through the perforated oesophagus. The patient was started on oral intake, which was well tolerated. This case highlights that conservative management may be appropriate.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Aged; Anti-Bacterial Agents; Antifungal Agents; Drainage; Esophageal Perforation; Fluconazole; Humans; Male; Mediastinal Diseases; Metronidazole; Pantoprazole; Parenteral Nutrition; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pleural Effusion; Proton Pump Inhibitors