Cefonicid concentrations in human aqueous humor.

One-gram doses of cefonicid sodium were given intravenously to patients prior to cataract surgery. Although serum levels were high, cefonicid levels in aqueous humor were low: mean peak concentrations of 0.25 and 0.27 mg/L were observed two and four hours after administration, respectively. The unusually high protein binding of cefonicid may explain these observations. The observed concentrations were not above the minimum inhibitory concentrations of cefonicid for those pathogens commonly involved in bacterial endophthalmitis.

Moxalactam concentration in human aqueous humor after intravenous administration.

Two grams of moxalactam disodium was administered intravenously to 20 patients before cataract extraction. Mean aqueous humor concentrations of moxalactam were 0.92, 0.87, 1.98, 2.13, and 1.24 micrograms/ml 30 minutes and 1, 2, 4, and 6 hours, respectively, after treatment. Adequate levels against Staphylococcus aureus and Staphylococcus epidermidis were not achieved. With the exception of Pseudomonas species, therapeutic levels three to ten times greater than the median minimum inhibitory concentration of moxalactam against Enterobacteriaceae were achieved for up to six hours after administration.

Cefaclor levels in human aqueous humor.

In an attempt to investigate penetration of cefaclor into human aqueous humor, we administered 500-mg and 1-g doses of cefaclor to 39 patients about to undergo cataract extraction. Average aqueous humor levels of 0.27, 0.27, and 0.17 microgram/mL were achieved at 1, 2, and 4 hours, respectively, after the 500-mg oral dose. After 1 g orally, we found average aqueous humor levels of 0.61, 0.64, 0.72, 0.4, and 0.31 microgram/mL at 1, 2, 3, 4, and 5 hours, respectively. Therapeutic levels in primary aqueous humor were consistently achieved against Streptococcus pneumoniae and St pyogenes, group A.

Cephradine levels in human aqueous humor.

In an attempt to investigate penetration of cephradine into the primary aqueous humor in man, we administered 500-mg and 1-g doses of cephradine orally to 27 patients about to undergo elective cataract extraction. A mean peak aqueous humor level of 0.87 microgram/mL was obtained at about three hours after the 500-mg dose. The mean peak aqueous humor level after the 1-g dose also occurred at three hours and was 1.99 microgram/mL, with a range from 0.91 to 3.25 microgram/mL. This concentration was greater than the median minimum inhibitory concentration (MIC) of cephradine for Streptococcus pneumoniae, Str pyogenes, and Staphylococcus aureus (when tested in nutrient agar) but was greater than the MIC for 90% of isolates only with Str pyogenes.

Ceftazidime concentrations in human aqueous humor.

Two grams of ceftazidime was given to 25 patients before cataract surgery. Mean aqueous humor concentrations of 2.8, 3.2, 3.39, and 1.94 micrograms/mL were observed 30 minutes and 1, 2, 4, and 6 hours, respectively, after administration of the drug. These concentrations are many times higher than the minimum inhibitory concentration (MIC) of ceftazidime against 90% ( MIC90 ) of isolates of Escherichia coli, Klebsiella sp, Proteus mirabilis, and indole-positive Proteus sp. The peak aqueous humor level was also equivalent to or slightly higher than the MIC90 for Pseudomonas aeruginosa.

Ceftriaxone. A new cephalosporin with aqueous humor levels effective against enterobacteriaceae.

One- or two-gram doses of ceftriaxone were administered intravenously to 30 patients before cataract extraction. With the 1-g dose, mean aqueous humor concentrations of 0.93 and 0.88 microgram/mL were found at approximately 2 and 12 hours after administration, respectively. With the 2-g dose, a mean level of 2.47 micrograms/mL was observed at two hours; levels of more than 2 micrograms/mL were found in two patients 13 hours after administration. Both the 1- and 2-g doses thus produce aqueous humor levels many times higher than the minimum inhibitory concentration of ceftriaxone for 90% of most Enterobacteriaceae, excluding Pseudomonas. Concentrations adequate for Staphylococcus aureus and Staphylococcus epidermidis were not, however, obtained.

Cefamandole levels in primary aqueous humor in man.

We administered cefamandole nafate to 69 patients before cataract extraction and assayed serum and aqueous humor for antibiotic content at the time of surgery. Average aqueous humor levels of 0.33, 0.59, 0.21, and 0.14 microgram/ml were achieved at one half, one, two and four hours, respectively, after a 1-g intravenous dose. After a 2-g intravenous dose, we found average aqueous humor levels of 1.26, 1.0, 1.57, 0.73, and 0.34 microgram/ml at one half, one, two, four and six hours, respectively. Therapeutic levels in primary aqueous humor effective against common grampositive pathogens were consistently achieved with the 2-g dose, but levels effective against Enterobactereaceae were attained only erratically.

Cefoxitin levels in human aqueous humor.

We administered 2 g of cefoxitin to 25 patients before cataract surgery. An additional 23 patients received 500 mg of probenecid 30 minutes before the 2-g doses of cefoxitin. Average aqueous humor levels of 1.54, 3.16, 2.46, 1.22, and 0.82 microgram/ml were achieved at 30 minutes and one, two, four, and six hours, respectively, after the 2-g dose. The addition of probenecid prolonged significant aqueous humor levels. Therapeutic levels against common gram-positive pathogens were consistently achieved at two hours after injection without probenecid and from two to four hours after injection with probenecid. Therapeutic levels effective against Enterobacteriaceae were inconsistent.

Cefoperazone concentrations in human aqueous humor after intravenous administration.

Twenty-four patients about to undergo elective cataract surgery received either a 2-g (ten patients) or a 4-g (14 patients) intravenous infusion of cefoperazone one to six hours before surgery. The 4-g dose produced a mean peak aqueous humor concentration of 2.93 micrograms/ml at one hour; the mean concentration remained higher than 2 micrograms/ml for at least four hours. These levels, however, were never more than 90% of the minimum inhibitory concentration of cefoperazone for common bacterial ocular pathogens.

Human vitreous levels of selected antistaphylococcal antibiotics.

Staphylococcus epidermidis and S. aureus are the most common causes of bacterial endophthalmitis. A study of the penetration of selected antistaphylococcal antibiotics into human vitreous was undertaken in 58 patients. After 2-g intravenous doses of cephalothin, cefazolin, methicillin, oxacillin, or nafcillin were given to patients about to undergo vitreous surgery, mean vitreous levels for each antibiotic were as follows: cephalothin, 0.97 microgram/ml in diabetics and 0.69 microgram/ml in nondiabetics; cefazolin, 0.84 microgram/ml in diabetics and 1.6 microgram/ml in nondiabetics; methicillin, 2.56 micrograms/ml in diabetics and 2.64 micrograms/ml in nondiabetics; oxacillin, 0.62 microgram/ml in diabetics and 0.34 microgram/ml in nondiabetics; and nafcillin, 0.73 microgram/ml in diabetics and 0.75 microgram/ml in nondiabetics. Only cefazolin produced vitreous concentrations consistently above its minimum inhibitory concentration for 90% of S. epidermidis isolates. Staphylococcus aureus isolates were not similarly covered. There was a trend toward higher vitreous antibiotic concentrations in patients with proliferative vitreoretinopathy and rubeosis.

Penetration of imipenem into human aqueous and vitreous humor.

Twenty-five patients about to undergo cataract surgery and ten patients about to undergo vitrectomy received a 1-g intravenous dose of imipenem before surgery. Specimens of aqueous or vitreous humor were then obtained and assayed for antibiotic content with a microbiologic disk agar technique. A mean peak aqueous humor level of 2.99 micrograms/ml was found at approximately two hours after administration, and a mean vitreous level of 2.53 micrograms/ml was found from two hours to three hours 15 minutes after administration. These concentrations were well above the minimum inhibitory concentration of imipenem for 90% (MIC90) of Staphylococcus epidermidis, S. aureus, and the Enterobacteriaceae commonly involved in bacterial endophthalmitis.

Human vitreous levels of cefamandole and moxalactam.

We gave 2-g intravenous doses of either cefamandole or moxalactam to 22 patients before vitrectomy. At 1 1/2 to 2 1/2 hours after administration, cefamandole vitreous concentrations varied from 0.36 to 2.05 micrograms/ml (mean, 0.94 micrograms/ml). Individual levels above the minimum inhibitory concentration of cefamandole for 90% (MIC90) of Staphylococcus aureus were found in five of 11 patients. Levels above the MIC90 for S. epidermidis were found in only two of 11 samples. Vitreous concentrations above the MIC90 of cefamandole for common gram-negative pathogens were found in only two patients. Moxalactam concentrations in the vitreous varied from 1.1 to 4 micrograms/ml 30 minutes to six hours after administration. These levels were not above moxalactam's MIC90 for S. aureus or S. epidermidis but were many times higher than the MIC90 of moxalactam for Enterobacteriaceae excluding Pseudomonas.

Rapid slide agglutination test for Lancefield grouping of streptococci.

A rapid slide agglutination test (the Phadebact [PB] Streptococcus test) was compared with the standard autoclave extraction method of Lancefield and presumptive clinical laboratory tests for grouping of streptococci (bacitracin disk sensitivity for group A and sodium hippurate hydrolysis for group B). Identification of group A streptococci by the PB kit was statistically as accurate as by the Lancefield method, whereas bacitracin grouping was significantly less accurate than the Lancefield method (P = less than .02). With regard to group B, there was no statistically significant difference between the PB test and the sodium hippurate test. The PB test correctly identified all group C and G streptococci. The PB kit provides a rapid and reliable method for Lancefield grouping of streptococci.

Effective school-based mental health interventions: advancing the social skills training paradigm.

Psychotherapeutic interventions with children have not been as successful in practice as laboratory studies suggest. Two weaknesses frequently cited include the failure of treatment gains to generalize to other times and settings and the lack of individualization. Although social skills interventions have inherent appeal and appear appropriate to address many of the social and emotional problems encountered by children and youth, they have not demonstrated effectiveness despite their widespread use. This article outlines four steps to improve social skills interventions that take advantage of the unique environments of schools and increase the likelihood that social skills interventions can achieve individualization and generalization.

Case report: prosthetic valve endocarditis caused by Pseudallescheria boydii and Clostridium limosum.

This report describes a patient with a combined infection due to Pseudallescheria boydii and Clostridium limosum on a prosthetic dura mater aortic valve homograft. While this patient had C. limosum only growing in blood cultures, both organisms were isolated from the surgically resected aortic valve. Because P. boydii is generally resistant to amphotericin B but susceptible to miconazole, accurate differentiation of P. boydii from other fungi which may appear similarly in tissue sections (e.g., aspergillus) is important.

Hepatitis from intravenous high-dose oxacillin therapy: findings in an adult inpatient population.

A retrospective review of all patients who received oxacillin intravenously in doses greater than 6 g/day was done. Eight patients in whom oxacillin-associated hepatitis developed were found and compared with a control group of 46 patients who had received high-dose oxacillin and in whom oxacillin-associated hepatitis did not develop. The latent period to development of typical symptoms of hepatitis varied from 2 to 21 days. Laboratory abnormalities were compatible with anicteric hepatitis and reverted to normal after withdrawal of the drug. Oxacillin hepatitis most like represents a hypersensitivity reaction. We recommend that routine liver chemistries be done regularly in all patients receiving high-dose intravenous oxacillin.