Ceforanide and cefazolin therapy of pneumonia: comparative clinical trial

Ceforanide is a new (parenteral) long-acting cephalosporin with antimicrobial activity comparable to those of other second-generation cephalosporins. In a randomized prospective study, patients with community-acquired bacterial pneumonia were treated with ceforanide at 0.5 g every 12 h (28 cases) or with cefazolin at 1.0 g every 8 h (26 cases). The study groups were comparable in clinical and laboratory findings, including etiological diagnosis. Streptococcus pneumoniae was isolated from the sputum of 38 patients, of whom 8 (21%) were bacteremic. Mean peak and trough serum levels of ceforanide drawn 1 and 11.5 h after the 0.5-g intravenous dose were 39.6 and 2.5 microgram/ml, respectively. Of the 50 patients evaluable for efficacy, all responded clinically with no serious adverse reactions. In spite of clinical improvement and in vitro susceptibility, Haemophilus influenzae persisted in the sputum of five of the eight cefazolin-treated patients and four of the five patients treated with ceforanide. Ceforanide appears to be as safe and effective as cefazolin for the therapy of pneumonia caused by S. pneumoniae or H. influenzae, but neither drug was effective in clearing H. influenzae from the sputum.

[Severe medical sequelae in heroin addicts]

Disease secondary to heroin abuse constitutes a rarity in Spain. While there had been no previous cases in earlier years four young heroin addicts were admitted to the Hospital "1st de Octubre" for severe medical complications of their addiction within the last twelve months. Two patients were admitted in deep coma due to drug overdose, being cardiac arrhythmias and pulmonary edema the main associated complications. Cardiac rhythm disturbances are due to a heightened vagal tone, either secondary to inhibition of acetylcholine hydrolysis or to hypoxia, hypercapnia, and acidosis, factors that diminish cholinesterase activity and act synergistically to increase vagal tone. Pulmonary edema secondary to heroin overdose is non-cardiogenic and probably due to hypoxia added to the local action of heroin on the alveolocapillary membrane. The goal of therapy in such cases is to obtain an appropriate alveolar ventilation, the use of continuous positive pressure ventilation being required when there is pulmonary edema. The third patient had staphylococcal pneumonia with multiple abscess formation secondary to venous septic embolization originated peripherally where the drug was injected. Finally, the fourth patient was admitted because of a clinical and biochemical picture of HBsAg negative acute viral hepatitis, having suffered a similar clinical picture three years previously.

Hematogenous staphylococcal pneumonia secondary to soft tissue infection

Staphylococcal pneumonia is rare, has a high mortality and morbidity rate, and occurs commonly during influenza epidemics (airborne) or during the course of right sided bacterial endocarditis in drug addicts (blood borne). In recent years, much emphasis has been given to the staphylococcal infections in intravenous drug abusers. This report describes ten patients with staphylococcal pneumonia resulting from soft tissue infection who were previously healthy and had no history of drug abuse. They were 12 to 45 years old. Eight were male patients. Soft tissue infection was community-acquired in nine and was most commonly located in the lower extremities. Three patients had diabetes. All presented with a clinical picture of acute pneumonia. Hemoptysis occurred in three. Chest roentgenogram showed multiple large or small round discrete densities in most of the patients. Lobar involvement was notably absent. Eight developed cavitary lesions in their lungs. The average length of hospital stay was 40 days. One patient died and six developed complications. Staphylococcal etiology should be suspected in patients with acute pneumonia who have soft tissue infection or have characteristic chest roentgenogram findings; antistaphylococcal agents should be included in the therapeutic regimens of such patients until the results of the cultures are known.

Current practices in antimicrobial dosing

There has been minimal utilization of pharmacologic principles in the establishment of treatment programs for many infectious diseases. Drugs with markedly different half-lives and peak levels in serum have been prescribed at the same dosage intervals. No attempt has been made to determine if the efficacy of dosing programs in which levels in serum that exceed bactericidal levels are achieved but in which doses are administered infrequently is greater than or equal to that of current programs. Double-blind studies of therapeutic programs in which drugs with different pharmacokinetic properties are compared are the only means of eliminating the current confusion regarding dosing practices.

Optimal antibiotic therapy in bronchopulmonary infections

Therapy of bronchopulmonary infections has evolved in the past 30 years. Only in the therapy of pneumococcal infections have, precise dosage programs been developed. Therapy of pneumococcal infection is optimal with penicillin G in low dosage. None of the newer agents has altered morbidity or mortality. The best agent for the treatment of pneumonia due to Staphylococcus aureus or members of the Enterobacteriaceae has not been established. Use of combination therapy consisting of an anti-Pseudomonas penicillin and an aminoglycoside has been shown to offer the greatest success in the treatment of Pseudomonas pulmonary infections. The optimal antibiotic and dosage program for the treatment of acute bacterial exacerbations of chronic bronchitis has yet to be defined. Further comparative studies of the chemotherapy of pulmonary infections are necessary.

Fatal Staphylococcus epidermidis sepsis following bone marrow transplantation

Staphylococcus epidermidis septicemia and pneumonia developed in an 18-year-old male undergoing bone marrow transplantation. The organism was isolated from multiple blood cultures, sputum cultures, an indwelling catheter tip and post-mortem lung biopsy specimens. The bacterium was resistant to penicillin, erythromycin, clindamycin, chloramphenicol, vancomycin, gentamicin, cephalothin and trimethoprim-sulfamethoxazole, but was sensitive to rifampin. The rapid demise of this patient, as well as the difficulty in achieving effective antibiotic therapy, illustrates the potential pathogenicity of this organism in immunosuppressed patients.

[A clinical evaluation of the effect of cephacetrile on bacterial pneumonia. A comparative test with cefazolin by a double blind method (author's transl)]

The therapeutic efficacy of cephacetrile (CEC) in bacterial pneumonia was evaluated in contrast with that of cefazolin (CEZ) by a double blind method. Both drugs were administered via intravenous route at a dose of 1 g twice daily for 14 days. 1) Of 81 patients, each 2 from both groups were eliminated from the study because of unknown results. In CEC group, 36 out of 38 obtained a slightly effective or better results (94.7% of effectiveness). In CEZ group, 31 out of 39 showed a similar result and there was no significant difference between the two groups. 2) In more detail, CEC achieved significantly better results in AaDo2 and cardiac insufficiency than CEZ, and this trend was also seen in dyspnea. 3) Regarding background factors, pretreatment severity was slightly in favor of CEC. However, so long as supplementary analysis is concerned, we could not find any relation between the pretreatment severity of symptom and drug efficacy or improvement of symptom. 4) Since there was a slight bias in the background factors, it is difficult to conclude that CEC is better than CEZ in terms of effectiveness. However, we consider CEC is superior to CEZ if compared in details. 5) Both drugs had the same incidence of side effect (6.25%, 3/48 in both groups). When clinical efficacy of CEC in bacterial pneumonia is evaluated together with the incidence of side effect, we may consider that CEC is an effective antibiotic agent equal to or better than CEZ.

[Substantiation for the kanamycin treatment of certain diseases, taking into account its concentration at the sites of localization of the causative agent (an experimental study)]

Kanamycin concentration in the inflammatory foci was studied on experimental models of pneumonia, maxillary sinusitis and acute dysentery. The kanamycin levels in the sites of the pathogen localization were lower than those in the same tissues of healthy animals. The antibiotic dose should be chosen with the account of its concentration in the focus of the pathogen localization rather than in the blood serum.

[Effectiveness of the inhalatory administration of chlolincocin in experimental staphylococcal pneumonia]

Administration of chlolincocin (7-chlor-7-desoxylincomycin) in the form of inhalation aerosol to albino mice in a dose of 200 Units/mouse provided the drug therapeutic concentrations in the lung tissue. The antibiotic was well adsorbed and detected in the blood, liver, kidneys and other biological substrates. Penetration of chlolincocin and lincomycin from the lungs into the blood was better in healthy animals. In animals with experimental staphylococcal infection their blood levels were 1.5--2 times lower. Repeated inhalations of chlolincocin resulted in an increase resulted in its levels in the lung tissue up to 8--10 Units/ml, however, its blood levels increased insignificantly. When chlolincocin and lincomycin were administered intravenously, their concentrations in the lung tissue were lower and detected for a shorter period of time than after the inhalation administration. The aerosols of chlolincocin markedly inhibited the growth of Staph. aureus in the lungs. The drug was 3--5 times more active than lincomycin. Inhalation administration of chlolincocin aerosol is supposed to be expedient for the treatment of inflammatory diseases of the respiratory organs caused by lincomycin sensitive flora.

Current status of treatment of pneumonia

Proper treatment of pneumonia is dependent upon a correct diagnosis. Pneumonia may be due to infectious agents, allergic phenomena, or chemical causes. Treatment regimens are outlined for the various types of pneumonia--pneumococcal, staphylococcal, fungal, and pneumonia due to gram-negative and anaerobic gram-negative bacilli, to Blastomyces dermatitidis, and to the parasite Pneumocystis carinii. In discussing current concepts of treatment, several well-known methods are emphasized, as well as newer developments, knowledge of which is essential for optimal treatment of pneumonia.

Generalized seborrhoeic dermatitis. Clinical and therapeutic data of 25 patients

Twenty-five infants with generalized seborrhoeic dermatitis have been studied with reference to the provision of optimum treatment. Leucocyte counts and chest x-ray examination are recommended in every case. Irrespective of clinical findings, antibiotics should be given to patients with overt bacterial infection and those with leucocytosis, shift to the left, and toxic granulation. One group of infants was treated with vitamin B complex plus biotin given slowly intravenously over 24 hours; a second group was given only biotin intravenously over 2-3 hours; and a third group only biotin over 1-2 minutes. A fourth group was treated with both biotin and antibiotics for confirmed or suspected superimposed bacterial infection. The results were excellent in all groups. Skin lesions improved within 4-8 days and cleared completely within 15-30 days. Intravenous administration of biotin is recommended as less painful and less dangerous than multiple intramuscular injections.

Subacute staphylococcal pneumonia in a renal transplant recipient

A patient is reported who developed subacute staphylococcal pneumonia 17 months after renal transplantation. Although the illness was modified by oral antimicrobial drugs, a remarkably benign course was observed, leading to a presumptive diagnosis of opportunistic fungal infection. Thus, staphylococcal pneumonia may complicate the differential diagnosis of pulmonary infection in transplant recipients.