Pharmacokinetics of amdinocillin and pivamdinocillin in normal volunteers.

The pharmacokinetic parameters of amdinocillin and pivamdinocillin were studied in 12 normal volunteers. Plasma amdinocillin concentrations were determined by microbiologic assay and urine concentrations by high performance liquid chromatography. Pharmacokinetic parameters were calculated by a two-compartment open model for the intravenous infusion and by a one-compartment model with zero-order absorption for the oral doses. The mean peak serum level after the intravenous infusion of 500 mg was 39 micrograms/ml. At one and a half hours after the oral administration of 250 mg and 500 mg doses, mean peaks were 1.93 and 2.66 micrograms/ml respectively. Half-life was one hour for all doses. Maximal plasma concentration did not increase proportionally with dose. Bioavailability was 45 percent after the 250 mg dose and 38 percent after the 500 mg dose.

The use of azlocillin to treat serious infections.

Azlocillin, a semisynthetic ureidopenicillin that inhibits many Gram-negative and Gram-positive bacteria and many Pseudomonas aeruginosa resistant to carbenicillin, was used to treat 23 episodes of infection in 20 patients. The majority of the patients had severe underlying diseases, including marked reduction in renal function in a number of the patients. Infection sites were lung, urinary tract, skin and primary bacteraemia. Seven patients had bacteraemia. Clinical cure or improvement was achieved in 87% of infections, all patients with bacteraemia due to Pseudomonas spp., Escherichia coli, Listeria spp. and Streptococcus faecalis were cured. Cure was achieved with azlocillin against carbenicillin-resistant Ps. aeruginosa infections. Serum and urine levels were easily maintained in excess of the accepted minimal inhibitory concentrations of the susceptible organism (less than or equal to 64 mg/l). Adverse effects were minor. Azlocillin was a safe, well-tolerated and effective agent to treat suspected or proven infections due to Ps. aeruginosa and other susceptible bacteria.

Bone and joint infections due to Salmonella.

A search of the records at the New York City Department of Health and the charts of patients at Columbia Presbyterian Hospital identified 37 cases of bone infection and nine cases of joint infection due to Salmonella between 1964 and 1978. Factors that apparently contributed to the development of either osteomyelitis or septic arthritis in 23 of the patients included hemoglobinopathy, previous trauma or surgery, connective tissue disorder, and lymphoma. Salmonella typhimurium and Salmonella enteritidis were the most common serotypes involved with bone infections, whereas members of the C1 serogroup were the most common cause of septic joint infections. Isolates of C1 serogroup Salmonella were represented in both bone and joint infections with frequencies (24% and 67%, respectively) disproportionate to the numbers of Salmonella isolated from other sources during this period. Therapy for joint infections was usually successful, with minimal residual damage. Therapy for acute osteomyelitis was unaccountably inadequate, with many patients (47%) developing chronic infections. Use of inappropriate therapy or an insufficient period of therapy were the most important factors contributing to poor outcome.

Error patterns of 3rd-year medical students on the cardiovascular physical examination.

BACKGROUND: Recent research documents widespread deficits in the physical examination skills of practicing physicians. PURPOSE: This study explored physical examination skills of 3rd-year medical students after completion of a course in physical diagnosis. METHODS: Standardized patient physical examination checklist data were analyzed for a cohort of 2,038 medical students for a patient presenting with classic signs and symptoms of an acute myocardial infarction. A follow-up paper case and survey explored reasons underlying omissions. RESULTS: Students systematically omitted 3 of 10 component maneuvers critical to the evaluation of a patient with shortness of breath and chest pain. The same pattern of omissions was observed across 8 medical schools and over 2 successive years. The paper case follow-up study ruled out time constraints and performance anxiety as the cause. Survey data revealed that students may omit a maneuver due to inability to recall pertinence (blood pressure in both arms) or difficulty discriminating findings (heart sounds at different locations), or because of inadequate technical mastery (percussion of the lungs). CONCLUSIONS: These data suggest fundamental inadequacies in the current paradigm for teaching physical examination skills. Standardized patient checklist data can provide an informative window into the efficacy of teaching practices.

The use of moxalactam in the treatment of serious infections due to multi-resistant organisms.

Moxalactam was evaluated as the sole therapy of 45 episodes of infection in 41 patients due primarily to bacteria resistant to older antibiotics. Infections included bacteremias, pulmonary, skin and soft tissue infections, osteomyelitis, and meningitis. Clinical and bacteriological cure was achieved in 69% of infections. Cure was achieved with moxalactam in patients infected with cefazolin-resistant, carbenicillin-resistant, chloramphenicol and gentamicin-resistant organisms. Although adverse reactions were generally mild, diarrhea developed in five patients, a major increase in prothrombin time and bleeding in three patients and a disulfiram reaction in two patients.