Treatment of gram-negative infections

Principles of antimicrobial therapy

It has been 2500 years since the Chinese began applying moldy soybean curd to cure skin infections. Technology today has refined the benefits of antibiotic-forming molds and bacteria and has greatly increased the number of antimicrobial drugs available to combat infection. Understanding the principles fundamental to rational therapy with these drugs will ensure the best of possible outcomes.

Pharmacokinetics of ampicillin administered intravenously and intraosseously to kittens

An aqueous solution of ampicillin sodium (100 mg ml-1) was administered intravenously and intraosseously to six kitten at 50 mg kg-1 in a crossover study. Jugular vein blood samples were taken at intervals up to eight hours after treatment and the serum ampicillin concentration-time data, derived from a microbiological assay, were analysed pharmacokinetically. The disposition kinetics of ampicillin administered by the two routes were very similar. The mean elimination half-life (t1/2 beta), the area-derived volume of distribution (Varea) and the total body clearance (ClB) values after the intravenous and intraosseous treatment were 86.3 and 79.0 minutes, 0.9 and 0.8 litre kg-1 and 7.3 and 7.6 ml min-1 kg-1, respectively. No side-effects related to the intraosseous administration of the drug were observed.

Treatment of open, delayed union, and nonunion fractures with external skeletal fixation

ESF is useful in treatment of open fractures and delayed union and nonunion fractures. The fixation pins can be placed away from the fracture site to avoid disruption of blood supply. The appliance is well tolerated and inexpensive, and many of the parts can be reused. Adjustment of the splint is possible to permit correction of stabilization for optimal results. Gradual reduction of frame rigidity improves the quality of healing by increasing the stress on the bone. As stiffness of the healing fracture increases, return of limb function occurs. Early fixator removal reduces patient morbidity and permits a return to normal activity.

The effects of experimentally induced bronchopneumonia on the pharmacokinetics and tissue depletion of gentamicin in healthy and pneumonic calves

The effects of a bovine bronchopneumonia model on the pharmacokinetics and tissue residue depletion profiles of gentamicin in calves weighing 90-140 kg was explored. Two groups of heifer calves were used. The first was a normal group, while the second group had bronchopneumonia induced. A scoring system was developed to evaluate the extent of disease in the groups. A bimodal distribution of the serum pharmacokinetic parameters in the pneumonic group was caused by the effects of dehydration. When the severely dehydrated calves were omitted from the analysis, serum clearance of gentamicin was significantly higher in the pneumonic group than in the normal group (P less than 0.05). The pharmacokinetic equations used to fit the tissue concentrations varied from tissue to tissue and between groups. Because the best equation of a particular tissue's concentrations varied between groups, withdrawal periods, which are normally determined in healthy animals, may be inappropriate in diseased animals. Addition of several parameters (serum creatinine, serum urea nitrogen, albumin, fibrinogen, and total protein concentrations, white blood cell counts, central fluid volume, volume of distribution at steady state, area under the serum concentration vs time curve, serum clearance, and elimination rate constant) to these tissue-depletion models using multiple regression improved the prediction of a concentration in a given tissue.