Continuous vs thrice-daily ceftazidime for elective intravenous antipseudomonal therapy in cystic fibrosis.

BACKGROUND/AIM: We hypothesized that a continuous 24-h infusion of 100 mg/kg per day ceftazidime (treatment C) would result in equivalent or even superior anti-infectious efficacy in chronic Pseudomonus aeruginosa (PA) infection in patients with cystic fibrosis (CF) in comparison to the usual application of 200 mg/kg per day ceftazidime in three doses (treatment T). METHODS: This was a randomized crossover study comparing outcome after 14 days and 35 days. Tobramycin administered once daily (10 mg/kg per day) was administered concomitantly in both groups. The primary end-point was a decrease in the leukocyte count, and the secondary endpoints were clinical and lung function parameters, Pseudomonas quantification in sputum, and inflammation markers (immunogloblulin [Ig] G, C-reactive protein [CRP]) in serum. All patients received antibiotics electively as 14-day courses on a regular basis, not for acute exacerbations. RESULTS: Fifty-six patients (29 females, mean patient age 14.4 years, age range 5-37) initially received treatments C or T, followed by the alternative treatment after a mean interval of 37 (+/- 21) weeks. After 2 weeks of antibiotic treatment, the overall study group showed significant improvements compared to baseline for body weight, leukocyte counts, CRP, forced expiratory volume in 1 s (FEV(1)), FVC (forced vital capacity), and bacterial load in the airways, with no significant differences between treatment groups. Both regimens were well tolerated. Three weeks after cessation of antimicrobial therapy, leukocytes and PA density had returned to pre-treatment values. CONCLUSION: We conclude that continuous or thrice-daily dosing of intravenous ceftazidime, both combined with once-daily tobramycin, are equally effective application regimens for elective antipseudomonal therapy in clinically stable patients with CF.

ENVIRONMENTAL AUDITING: Environmental Auditing in Hospitals: First Results in a University Hospital.

/ While medical audit in infection control today is one important element in the quality assurance of health care, environmental auditing, approved in 1993 by the Council of the European Communities for the industrial sector, so far has not been used as a tool to control and reduce environmental pollution caused by medical care. The aim of this study was to investigate whether environmental auditing according to the European Eco-Management and Audit Scheme (EMAS) can be implemented in hospitals as a process of improvement in protection of the environment. In a prior publication the methodological issues and the organizational steps that had to be taken were described. An environmental review of the activities of the Freiburg University Hospital and an ecoanalysis of the input and output were performed. The results of this analysis, published in an environmental report, provide a fundamental data set for the consumption of energy, water, materials, and the burdens of major pollutants and waste. Regarding the organizational structure of the hospital, the first steps towards an integrating environmental management system as demanded by EMAS could be taken. Beside supporting advantages, e.g., improvement of environmental safety, public image and staff contentment, and potential economic benefits such as less cost to be paid for energy and water consumption, there are important restrictions of environmental auditing in hospitals. Examples are the lack of basic environmental data, staff motivation (especially of physicians), cooperation of the organizational substructures, and funds for prefinancing urgently needed improvements in ecology. Based on the study findings, a textbook on environmental auditing in hospitals, including checklists covering all important environmental objectives, has been published to support hospitals in their efforts to achieve an optimized and sustainable practice of providing health care.