Blood, tissue, and intracellular concentrations of azithromycin during and after end of therapy.

Although azithromycin is extensively used in the treatment of respiratory tract infections as well as skin and skin-related infections, pharmacokinetics of azithromycin in extracellular space fluid of soft tissues, i.e., one of its therapeutic target sites, are not yet fully elucidated. In this study, azithromycin concentration-time profiles in extracellular space of muscle and subcutaneous adipose tissue, but also in plasma and white blood cells, were determined at days 1 and 3 of treatment as well as 2 and 7 days after the end of treatment. Of all compartments, azithromycin concentrations were highest in white blood cells, attesting for intracellular accumulation. However, azithromycin concentrations in both soft tissues were markedly lower than in plasma both during and after treatment. Calculation of the area under the concentration-time curve from 0 to 24 h (AUC(0-24))/MIC(90) ratios for selected pathogens suggests that azithromycin concentrations measured in the present study are subinhibitory at all time points in both soft tissues and at the large majority of observed time points in plasma. Hence, it might be speculated that azithromycin's clinical efficacy relies not only on elevated intracellular concentrations but possibly also on its known pleotropic effects, including immunomodulation and influence on bacterial virulence factors. However, prolonged subinhibitory azithromycin concentrations at the target site, as observed in the present study, might favor the emergence of bacterial resistance and should therefore be considered with concern. In conclusion, this study has added important information to the pharmacokinetic profile of the widely used antibiotic drug azithromycin and evidentiates the need for further research on its potential for induction of bacterial resistance.

Blood, tissue, and intracellular concentrations of erythromycin and its metabolite anhydroerythromycin during and after therapy.

For macrolides, clinical activity but also the development of bacterial resistance has been attributed to prolonged therapeutic and subtherapeutic concentrations. Although erythromycin is a long-established antimicrobial, concomitant determination of the pharmacokinetics of erythromycin and its metabolites in different compartments is limited. To better characterize the pharmacokinetics of erythromycin and its anhydrometabolite (anhydroerythromycin [AHE]) in different compartments during and after the end of treatment with 500 mg of erythromycin four times daily, concentration-time profiles were determined in plasma, interstitial space of muscle and subcutaneous adipose tissue, and white blood cells (WBCs) at days 1 and 3 of treatment and 2 and 7 days after end of therapy. In WBCs, concentrations of erythromycin exceeded those in plasma approximately 40-fold, while free concentrations in plasma and tissue were comparable. The observed delay of peak concentrations in tissue might be caused by fast initial cellular uptake. Two days after the end of treatment, subinhibitory concentrations were observed in plasma and interstitial space of both soft tissues, while 7 days after the end of treatment, erythromycin was not detectable in any compartment. This relatively short period of subinhibitory concentrations may be advantageous compared to other macrolides. The ratio of erythromycin over AHE on day 1 was highest in plasma (2.81 ± 3.45) and lowest in WBCs (0.27 ± 0.22). While the ratio remained constant between single dose and steady state, after the end of treatment the concentration of AHE declined more slowly than that of the parent compound, indicating the importance of the metabolite for the prolonged drug interaction of erythromycin.

Prevalence of nosocomial infections in high-risk units in the university clinical center of Kosova.

A point-prevalence study was performed to determine the prevalence of nosocomial infections in University Clinical Center of Kosova. Of 167 surveyed patients, 27 had a total of 29 nosocomial infections, with an overall prevalence rate of 17.4%. Nosocomial bloodstream infections were most prevalent (62%). The prevalence was highest among neonates in intensive-care units (77.8%).

Infection control in Kosova.

This article presents the authors' views on infection control in hospitals in Kosova, focusing on the main problems and appropriate solutions. Past and present government initiatives are briefly presented, and available data on the prevalence of hospital infections and antimicrobial resistance in Kosova are outlined.

A comparison of three single layer anastomotic techniques in the colon of the rat.

INTRODUCTION: Although intestinal anastomoses are mainly made by staplers, manual anastomoses are still in use worldwide. In previous studies, single layer anastomosis has shown better results compared to double layer techniques. PURPOSE: To test experimentally some aspects of three different single layer anastomotic techniques in order to identify advantages and disadvantages of each. MATERIAL AND METHODS: The study was done on Sprague Dawley rats. Animals were randomly divided into four groups. Three experimental groups consisted of 21 animals each, and the fourth sham group contained 10 animals. By 7 animals of each group were sacrificed on the 4th and the rest of 14 animals on the 7th postoperative day. In all groups the resected distal part of the colon was anastomosed using Halsted, Gambee and Gambee-Halsted technique. To evaluate each specific technique the following were used: postoperative complication frequency, biomechanical measurements, adhesion density, condition of intestinal lumen and histological parameters of the healing process. RESULTS: The complication frequency was not significantly different between the tested techniques. The average bursting pressure and tensile strength were higher on both the 4th and 7th postoperative days with the Gambee technique. In the colon segments removed on the 4th postoperative day 97% of pressure induced ruptures occurred in the anastomotic line, whereas on the 7th postoperative day 76% of ruptures occurred about 1cm distal to the anastomotic line. CONCLUSION: The Gambee technique had significantly better biomechanical and histological results compare to the other two anastomotic techniques. Adhesion density was significantly lower in the control group (p<0.001).