Imipenem/cilastatin: a multicentre international study of its clinical efficacy, safety and potential as empirical therapy

Five hundred and sixty-nine patients were treated with imipenem/cilastatin in this multicentre, international noncomparative study of hospitalized patients with moderate to severe infections; 97.5% of 815 pathogens isolated were susceptible to imipenem, which reconfirms imipenem's broad in-vitro spectrum. Clinical efficacy could be assessed in 389 patients, the majority (72%) of whom received a daily dose of 1.5 g or less. Infections in the various body sites with the exception of the central nervous system were treated. A favourable clinical outcome was seen in 93% of the infections. Fifty-five of the 389 patients had been unsuccessfully treated with one or more antibiotics before being switched to imipenem/cilastatin. In these patients the daily dose was evenly distributed between 1.5 g/day (47%) or 2.0 g/day (40%); the rest of the patients received greater than 2 g/day. Intra-abdominal and respiratory tract infections were the most common, the majority (56%) of which were rated severe. Overall clinical efficacy (cured or improved) in these 55 patients was 82%. With the demonstrated clinical efficacy, particularly in the treatment of proven infections which have failed on other regimens, imipenem/cilastatin could have a distinct advantage as an initial choice for empirical therapy.

Canine chronic renal disease: prevalence and types of glomerulonephritis in the dog

In a prospective survey, one hundred and eleven dogs with canine chronic renal disease, presenting to 24 veterinary practices in East Anglia and the West Midlands (geographical area 8,600 square miles) were identified. More than 20 different breeds were represented. In 76 cases, clinical details, blood and urine biochemistry, serology and kidney tissue for light and electron microscopy, and immunohistochemistry were obtained. Forty (52%) had glomerular (GN) and 36 (48%) non-glomerular (NGN) disease. Types of GN identified were (W.H.O. classification, number of cases in brackets): focal glomerulonephritis (gn) (5), diffuse mesangial proliferative gn (8), diffuse endocapillary proliferative gn (2), mesangiocapillary gn type I (8), diffuse crescentic gn (1), diffuse sclerosing gn (7), amyloid (6), unclassifiable gn (3). Eight dogs with GN and 13 with NGN had extra-renal lesions. In only one GN case (bacterial endocarditis) was the etiology clear. Proteinuria, but not age, breed, sex, serum creatinine or hematuria, discriminated between GN and NGN groups. This prospective survey identifies GN, with morphological types as found in humans, as a common cause of canine chronic renal disease.

Genes encoding the T-cell antigen receptor

The search for the elusive and controversial T-cell antigen receptor is over. It is now clear that gene complexes for both alpha and beta chains are distinct from those for immunoglobulin genes. They are, however, related to Ig genes as well as to other class I and class II major histocompatibility complex (MHC) gene products. Therefore, they belong to the immunoglobulin super gene family.

Comparative multiple dose kinetics of two formulations of indomethacin

The kinetics of a controlled release (CR) formulation of indomethacin 75 mg (Indocid-Retard) given once daily was compared with a conventional 25 mg indomethacin capsule (Indocid) given 3 times daily for 7 days, to 14 healthy volunteers, using a randomized, cross-over, multiple-dose study design. The following differences in plasma indomethacin profiles after the 2 treatments were observed: average peak concentrations (Cmax) for the CR regimen were higher and the time to peak (Tmax) was significantly delayed. Trough (pre-morning dose) plasma concentrations (Cmin) on Days 2, 5, 6 and 7 were significantly lower after the CR-formulation. No statistically significant differences between preparations for area under the plasma concentration time curve (AUC0-24 h) or for renal clearance were observed. Average steady-state plasma concentrations (Cssp) on Day 7 of the multiple dose regimens averaged 0.477 and 0.427 microgram/ml for the 75 mg CR once daily and the conventional 25 mg t.i.d. treatments, respectively. These results show that the bioavailability of the CR and conventional indomethacin formulations under these multiple-dose conditions was not significantly different.

Enhancement of uricosuric properties of indacrinone by manipulation of the enantiomer ratio

Racemic indacrinone is a high-ceiling, relatively long-acting diuretic. Both enantiomers have uricosuric activity, but the diuretic activity resides predominantly in the (-) enantiomer. Usual therapeutic doses of racemic indacrinone have only transient uricosuric activity, so that, as with other diuretics, hyperuricemia occurs. Sixty-five healthy men participated in a multicenter, double-blind, randomized, balanced, incomplete-block study comparing the effects on plasma urate and urate clearance of indacrinone (-) enantiomer 10 mg given concomitantly with 0, 10, 20, 40, and 80 mg (+) enantiomer (10/0, 10/10, 10/20, 10/40, 10/80), as single daily doses for 7 days. Hydrochlorothiazide (HCTZ) 50 mg daily and ticrynafen (T) 250 mg daily were controls. Each subject received two of the seven treatments, so that there were 18 subjects per treatment. On days 7 to 8, morning (mean of 0-hr values on days 7 and 8), HCTZ, 10/0, 10/10, and 10/20 elevated plasma urate by 8% to 16%. 10/40 was approximately isouricemic, and 10/80 and T lowered plasma urate by 13% and 41%. There were corresponding changes in urate clearance.

Dynamics and kinetics of ophthalmic timolol

Timolol is a beta adrenergic antagonist in 0.25% or 0.5% eyedrop solution for glaucoma. In a double-blind crossover study in healthy males we measured systemic beta blockade, intraocular pressure, and timolol kinetics after the first and ninth 12-hourly dose of a 0.5% ophthalmic solution. Timolol ophthalmic and placebo were each given as 2 drops to each eye with precautions to prevent the normal loss of drug in tears and overflow (high dose) and as 1 drop to each eye with no special precautions (standard therapeutic dose). Exercise tachycardia, measured at 70 and 255 min after administration of drug, was lower at both levels. Postexercise 1-sec forced expiratory volume (FEV1) was not affected. Intraocular pressure measured at 3 and 8 hr after drug was lower at both dose levels. Timolol was consistently present in urine but was not detectable in most plasma samples. Dynamic effects were not greater after the ninth than after the first dose, and the urinary excretion data provided no evidence of drug cumulation.

What shall we do with the drunkenness offender?

In England, public intoxication has been a criminal offence ever since an Act of Parliament was passed in the reign of James I, somewhat over three and a half centuries ago. Edwards (1970) compiled some figures on these offences for the last two hundred years, showing that the rate of arrest was much higher in the nineteenth century than at present. For example, in 1878 there were 70 arrests per 10,000 of the population, compared with a comparable figure for 1968 of 16. Nevertheless, the latest available figures from the Home Office (1971) show that 82,961 persons were found guilty of simple or aggravated public drunkenness in 1971. In the U.S.A., with its apparently much larger alcoholism problem, there were nearly one and a half million arrests for this group of offences in 1966 (Pittman, 1969); this accounts for one third of all arrests in that country (Chafetz, 1971).