Urinary kidney-derived antigens determined by tests built on monoclonal antibodies: new markers for kidney damage

We have developed a series of sandwich ELISA for the quantitation of kidney derived urinary antigens (UA) utilizing monoclonal antibodies specific for antigens localized in cells of defined subunits of the nephron of human kidney. Antigens derived from the distal and proximal parts of the tubular system as well as antigens localized over its entire length can be detected and quantified in urine samples. Antigen excretion was measured in the urine of healthy individuals, patients with various diseases with and without kidney involvement, kidney transplant recipients, and healthy volunteers after receiving antibiotics. Low antigen excretion values were found in healthy individuals, patients with diseases primarily affecting the glomerulus, and inactive phases of chronic diseases. Toxic side effects of drugs were reflected by slightly (antibiotic drugs) or strongly (cytostatic drugs) enhanced antigenuria. Excretion of some or all of the antigens was always indicative of massive alteration of tubular structures, such as in acute phases of tubulointerstitial disease or during rejection episodes in kidney transplant recipients. The results obtained indicate that it is possible to obtain information on the location and extent of acute primary processes in the kidney with these tests.

Flucloxacillin-induced cholestatic liver damage

Two female patients (75 and 68 yr old) developed jaundice 4 and 7 weeks respectively after treatment with flucloxacillin. Liver biopsies showed intrahepatic cholestasis. After cessation of the drug, the liver tests became normal.

A clinical appraisal of flucloxacillin in the management of skin and soft tissue infections in Nigeria

The resolution of skin and soft tissue infections following a single course of treatment with flucloxacillin was assessed in 235 patients recruited by nineteen physicians. In all, 88.5% of patients were completely cured or showed a highly satisfactory improvement after 3 to 12 days' treatment. Only three patients failed to show any improvement at all. Side-effects were limited to twelve patients (5.1%) all of whom were able to complete their course of treatment.

Antitoxin production in antibiotic-associated colitis?

The production of antitoxin after Clostridium difficile-induced diarrhoea has not been reported previously. The stool of a patient with prolonged antibiotic-associated diarrhoea contained C. difficile toxin, and the serum neutralised the cytopathic effect of C. difficile toxin in tissue culture.

Inadvertent intra-arterial injection of flucloxacillin

Flucloxacillin 500 mg in 5 ml water was accidentally injected into a radial artery. This resulted in gangrene of parts of the thumb, index and middle fingers, necessitating amputation. Gangrenous areas requiring skin grafting also occurred in the forearm.

Short-term adverse effects of antibiotic prophylaxis for open-heart surgery

A study was made of the incidence of postoperative endocarditis and of septicaemia in early convalescence in 814 consecutive patients undergoing open-heart surgery. The results were related to the prophylactic antibiotic given to "cover" the operation. A subgroup of 150 patients was studied more intensively and the bacterial flora of the tracheal aspirates and catheter tips from these patients have been related to the antibiotics used. The results demonstrate that the use of a narrow spectrum agent (flucloxacillin) is associated with a modest change in bacterial flora at the two sites sampled, but that much more pronounced shifts in flora are found with a more broad spectrum agent (cephradine). The changes in flora have been related to the incidence of septicaemia in early convalescence, which was higher (7.7%) in the cephradine group than in the flucloxacillin group (0.9%). Since the overall incidence of prosthetic infection using flucloxacillin was acceptably low (0.49% of perfusions; 0.56% of valve insertions), it is concluded that narrow spectrum prophylaxis offers the better overall choice, at least until more objective comparisons are made.

Phlebitis induced by parenteral treatment with flucloxacillin and cloxacillin: a double-blind study

Two studies were performed on a total of 54 patients with staphylococcal infections. Study I compares with phlebitogenic properties of flucloxacillin after intravenous infusions when either saline or sterile water was used as a solvent. No difference was observed between the two solvents, and the frequency of phlebitis for the total material without respect to solvents was 5% after 1 day of treatment and 13% after 2 days. Study II was a double-blind comparison of phlebitis caused by intravenous infusions of either flucloxacillin or cloxacillin. The frequencies of phlebitis were found to be 18 and 13%, respectively. After 2 days of treatment the frequency of phlebitis increased dramatically for both drugs. All infusions were given through a plastic cannula of 5-cm length and 1.2-mm diameter.

Clostridium difficile isolated from the stool of a patient with pseudomembranous colits following ampicillin plus flucloxacillin (Magnapen) therapy

A case is reported of the isolation of Clostridium difficile from the stool of a patient with antibiotic-related pseudomembranous colitis.

A general practice trial of an amoxycillin/flucloxacillin combination (Suprapen) in proven bacterial infections

Ninety-three cases of proven bacterial infection occurring in general practice were treated with an amoxycillin/flucloxacillin combination. There was a satisfactory clinical response in 98% of patients and an overall bacteriological success rate of 95.7%. Eleven patients (9.1%) complained of side-effects but withdrawal of the combination was necessary in only one patient who developed a rash.

Flucloxacillin (floxapen) in the treatment of skin and upper respiratory tract infections

An appraisal of flucloxacillin (floxapen) for the treatment of infection of the skin and upper respiratiory tract was carried out in general practice by 34 doctors. The success rate in the treatment of skin infections was assessed as 92 percent and in upper respiratory tract infections as 84 percent. The incidence of side effects overall was 9.5 percent and their nature and severity are described. Also the results of the present study are compared with previous appraisals of flucloxacillin in general practic and the difference in dose regimes used in these studies is discussed.

Pharmacokinetics of flucloxacillin and cloxacillin in healthy subjects and patients on chronic intermittent haemodialysis

1 A pharmacokinetic study on flucloxacillin and cloxacillin was performed to investigate the factors contributing to the higher serum concentrations reported for the former after oral administration. 2 The results obtained in a study performed in a group of volunteers with flucloxacillin administered orally and by continuous infusion, were compared with the results of a similar investigation with cloxacillin. Patients on chronic intermittent haemodialysis received flucloxacillin orally and as a single i.v. injection. The results of this part of the study were compared with those of an earlier study on cloxacillin in haemodialysis patients. Serum and urine concentrations of flucloxacillin and cloxacillin were determined by bio-assay, and a one-compartment model was used for the calculations. 3 Higher serum concentrations reached after oral administration of flucloxacillin as compared with cloxacillin were based not only on better oral absorption (53.7% and 32.9%, respectively) but also on slower (renal and extra-renal) elimination (T1/2 : 46 and 32 min, respectively). A significant difference between the apparent volumes of distribution of flucloxacillin and cloxacillin, which could contribute to higher serum concentrations, could not be demonstrated. Considerable individual variation occurs in the rate and amount of oral absorption, especially in patients. The elimination rate of flucloxacillin in haemodialysis patients (T1/2 : 2h 53 min) corresponds with the extra-renal elimination rate in healthy subjects. No influence of haemodialysis on the elimination rate constant of flucloxacillin was found; total plasma clearance was, however, slightly but significantly higher during dialysis.