[Clinical efficacy of a novel antimicrobial drug combination containing ciprofloxacin and tinidazole in the treatment of patients with skin and soft tissue infections].

Clinical and microbiological efficacies of a combined drug, a fixed combination of ciprofloxacin and tinidazole in the form of tablets (Cifran ST, Ranbaxy, India) were studied. The drug was given to 40 patients with skin and soft tissue infections in the complex surgical treatment. The clinical effect and bacteriological efficacy were observed in 97.5 and 75% of the cases respectively. The drug tolerability was good and no adverse reactions were stated.

[Use of pefloxacin in the treatment of patients with purulent wounds of soft tissues]. / Primenenie pefloksatsina dlia lecheniia bol'nykh s gnoinymi ranami miagkikh tkanei.

Pefloxacin was used in the treatment of 25 patients with wound infection in a dose of 400 mg orally twice a day for 10-12 days. As the monotherapy it was applied to 15 patients. 7 patients with clinical signs of non-clostridial anaerobic infection were treated with pefloxacin in combination with intravenous metronidazole. Pefloxacin was highly efficient in 96 per cent of the cases with extensive posttraumatic purulent wounds with and without bone affection, acute purulent wounds of the soft tissue, purulent wounds of the soft tissues in diabetic patients, trophic or decubitus ulcer. 266 clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus mirabilis, Enterobacter spp. and Acinetobacter spp, were tested and 75 to 100 per cent of them was shown to be susceptible to pefloxacin and ciprofloxacin. At the same time the isolates of Pseudomonas aeruginosa and Klebsiella spp. were more susceptible to ciprofloxacin. The pathogen eradication and eradication with superinfection in the cases treated with pefloxacin amounted to 92 per cent. The drug tolerance was good. No clinically significant adverse events were recorded.

[The results of a multicenter study of the comparative activity of cefepime and other antibiotics against the causative agents of severe hospital infections (the Micromax program)]. / Rezul'taty mnogotsentrovogo issledovaniia sravnitel'noi aktivnosti tsefepima i drugikh antibiotikov v otnoshenii vozbuditelei tiazhelykh gospital'nykh infektsii (programma "Micromax").

A multicentre trial was performed on the activity of cefepime in comparison with ceftazidime, ceftriaxone, piperacillin/tazobactam, imipenem and ciprofloxacin against severe hospital infection pathogens in intensive care units. The isolates of Escherichia coli and Proteus spp. from the majority of the centres were highly susceptible to the antibiotics (90 to 100 per cent of the isolates). In some centres up to 40 per cent of the isolates produced ESBL. The isolates of Klebsiella spp. were characterized by lower susceptibility, in some centres the frequency of the strains producing ESBL exceeded 90 per cent, by the MIC geometric mean cefepime was superior to the third generation cephalosporins, the frequency of resistance to ciprofloxacin ranged from 0 to 31 per cent, no resistance to imipenem was recorded. The frequency of resistance to the third generation cephalosporins and piperacillin/tazobactam in Enterobacter spp., Serratia spp., Citrobacter spp., Morganella spp., and Providencia spp. ranged from 10 to 52 per cent, the resistance to cefepime equaled 0-11 per cent, 0 to 17 per cent of the isolates were resistant to ciprofloxacin, some isolates were resistant to imipenem. As for the nonfermenting microorganisms their resistance to all the antibiotics tested was comparatively high and markedly differed in various centres. As a whole, 7 per cent of all the isolates of the nonfermenting organisms was resistant to cefepime, 10 per cent was resistant to imipenem, 17 per cent was resistant to ceftazidime, 21 per cent was resistant to piperacillin/tazobactam and 36 per cent was resistant to ciprofloxacin.

[Multicenter open randomized trial of meropenem in comparison to ceftazidime and amikacin used in combination in severe hospital infections]. / Mnogotsentrovoe otkrytoe randomizirovannoe issledovanie meropenema v sravnenii s kombinatsiei tseftazidima i i amikatsina pri tiazhelykh gospital'nykh infektsiiakh.

Clinical efficacy and tolerance of meropenem were estimated by comparison with those of ceftazidime and amikacin used in combination in the therapy of hospital infections of the lower respiratory tract, skin and soft tissues, intraabdominal and gynecologic infections, urinary tract infection and sepsis. 48 patients were given meropenem in a dose of 1 g every 8 hours for 3-14 days (the average of 9 days). 47 patients were subjected to the routine combined therapy: ceftazidime in a dose of 1 g every 8 hours and amikacin in a dose of 0.5 g every 12 hours for 2-14 days (the average of 9 days). The patient groups were comparable by the age, nature and severity of the infection and the condition (the mean APACHE II of 9.1 and 8.9). By the end of the treatment a positive clinical effect (recovery and improvement) was observed in 47 patients (97.9 per cent) treated with meropenem and in 41 patients (89.1 per cent) subjected to the combined therapy. The infection relapse within 4 weeks after the treatment completion was recorded in 3 patients in every group. Before the treatment 133 microbial strains were isolated from the patients. 121 of them were susceptible to meropenem (91.1 per cent), 111 to amikacin (83.4 per cent) and 90 to ceftazidime (67.7 per cent). The difference between meropenem and ceftazidime was significant (p = 0.0005). Eradication of the primary pathogens at the background of the meropenem therapy was stated in 41 out of 44 patients (93.2 per cent) and that of the combined therapy in 38 out of 43 patients (88.4 per cent). The microbiological relapse after the treatment completion was recorded in 3 and 2 patients, respectively. Side effects were observed in 8.3 per cent of the patients treated with meropenem and in 10.6 per cent of the patients subjected to the combined therapy. The trial results were indicative of the meropenem high efficacy and good tolerance and of the possible use of the drug in the monotherapy as an alternative of the routine combined therapy of severe hospital infections.

[Clinico-laboratory study of piperacillin/tazobactam in the treatment of patients with would infection]. / Kliniko-laboratornoe izuchenie piperatsillin-tazobaktama pri lechenii bol'nykh s ranevoi infektsiei.

Piperacillin/tazobactam (P/T) or tazocin was used in the treatment of 40 patients with soft tissue purulent necrotic wounds of various genesis and localization. In the majority of the patients the affection was of recurring nature. P/T was administered in a dose of 4.5 g 3 times a day for 1 to 14 days (mainly for 8 to 10 days) as 30-minute intravenous infusions. The clinical effect of the treatment was stated in 36 patients (90 per cent). In 3 out of 8 patients with diabetes mellitus the treatment failed. In 1 patient the treatment was discontinued after the first dose because of asphyxia and a short-term decrease of the arterial pressure. Among 105 microbial strains isolated from 75 patients 64 were highly susceptible to P/T, 33 were moderately susceptible and 8 were resistant. 76.3 per cent of the isolates produced beta-lactamase, 66.3 per cent of them were susceptible to P/T. 54 gram-positive and gram-negative strains were isolated from 40 patients. 16 out of the 54 strains were isolated as monocultures and the others as associations. After the treatments the pathogen eradication and the pathogen eradication followed by superinfection were stated in 26 patients (66.7 per cent). In 11 patients (28.2 per cent) the pathogen persistence was observed at the background of the clinical improvement in the majority of the patients. The relapses were recorded in 2 patients (5.1 per cent).

[Use of pefloxacin in the treatment of infected burn wounds]. / Primenenie pefloksatsina dlia lecheniia infitsirovannykh ozhogovykh ran.

The efficacy of a home-made pefloxacin was estimated in clinico-laboratory trials including 25 patients with wound infection. The fluoroquinolone was used in a dose of 400 mg administered orally twice a day for 4-16 days. Good and satisfactory results were stated in 24 patients (96 per cent). The isolates from the patients were mainly susceptible to the drug (86.2 per cent). The bacteriological efficacy amounted to 92 per cent. No side effects to the use of pefloxacin were observed.

[Use of aztreonam for the purpose of preventing postoperative purulent complications]. / Primenenie aztreonama s tsel'iu profilaktiki posleoperatsionnykh gnoinykh oslozhnenii.

The efficacy of the prophylactic use of azthreonam, a monocyclic beta lactam antibiotic, was studied in 20 patients operated for liver diseases. The drug was administered intramuscularly in a dose of 1 g 30 minutes prior to the operation. During the postoperative period the drug was administered in a dose of 1 g 4-5 times a day for 4 to 5 days. The clinical effect in all the patients was good: no elevation of the body temperature above 37.5 degrees C and no suppuration of the operation wound. Adverse reaction to the treatment were not observed. 135 clinical isolates were tested for the susceptibility to azthreonam. The most susceptible gram-negative bacteria were the following: E coli (100 per cent), P. mirabilis (100 per cent), M. morganii (100 per cent), P. rettgeri (100 per cent) and Citrobacter sp. (84 per cent). P. aeruginosa, Acinetobacter, P. vulgaris and Enterobacter were less susceptible (64, 50, 50 and 47.5 per cent respectively). All the S. aureus isolates were resistant.

[Use of cefpirome in the treatment of patients with skin and soft tissue infections]. / Primenenie tsefpiroma pri lechenii bol'nykh s infektsiiami kozhi i miagkikh tkanei.

The efficacy of cefpirome was estimated in the treatment of 25 patients: 15 patients with pyo-necrotic wounds of the soft tissue of various genesis and localization and 10 patients with deep thermal burns involving 8 to 40 per cent of the body surface. The clinical and bacteriological efficacies of the treatment in the patients with the wound infection amounted to 100 and 80 per cent respectively. In the patients with the burn infection the respective values were 90 and 80 per cent. The drug tolerance was good. Adverse reactions were observed in 1 patient. Bolus intravenous administration of the drug was preferable by comparison with the injections.

[Ten-year experience with the use of ofloxacin in the treatment of wound infection]. / Desiatiletnii opyt ispol'zovaniia ofloksatsina pri lechenii ranevoi infektsii.

The experience with ofloxacin used for 10 years from 1986 to 1995 in the complex therapy of 208 patients with wound infection complicated in 51 patients (24.5 per cent) by respiratory tract infection such as purulent tracheobronchitis or pleuropneumonia was generalized. In 28 patients (13.5 per cent) persistent bacteriuria not susceptible to the routine drugs was stated. The clinical and bacteriological efficacies of ofloxacin in the group of the patients with noncomplicated purulent wounds of the soft tissues amounted to 85-91 and 74-80 per cent respectively. In the group of the patients with wound infection complicated by respiratory or urinary tract infection the clinical and bacteriological efficacies equaled 94-100 per cent. The appetite disorder, epigastric pain or nausea were rare. Only in 3 cases the adverse reactions required the treatment discontinuation. Despite the use of ofloxacin for many years, the susceptibility of the main causative agents of surgical infections to the drug remained high: Staphylococcus epidermidis 93.3 per cent, Staph.aureus 94.5 per cent, Pseudomonas aeruginosa 96.5 per cent, Escherichia coll 100 per cent, Proteus spp. 100 per cent, Enterobacter spp. 100 per cent, Acinetobacter spp. 82.3 per cent and Klebsiella spp. 88.8 per cent. The successive use of ofloxacin, at first intravenously for 3-5 days and then orally in the form of tablets for 3-5 days, in the treatment of 15 patients with wound infections of various genesis and localization subjected to osteoplastic reconstructive operations provided positive effects in all the cases and was economically advantageous.

[Ofloxacin in comprehensive treatment of infections in burn patients]. / Ofloksatsin v kompleksnom lechenii infektsii u obozhzhennykh.

The experience with ofloxacin in the prophylaxis and treatment of infected burn wounds in 40 patients was investigated. High clinical and microbiological efficacy of the drug was stated (82.5 and 83 per cent respectively). The highest efficacy of ofloxacin was observed when the burned area did not exceed 25 per cent of the body surface. It was concluded that the prophylactic use of the drug during acute burn toxemia was not expedient.

[Cefpiramide (Tamicin) in the treatment of purulent complications of abdominal surgery]. / Primenenie tsefpiramida (tamitsina) dlia lecheniia gnoinykh oslozhnenii v abdominal'noi khirurgii.

Fifty patients with purulent infection of the abdominal cavity were treated with cefpiramide (Lek, Slovania). The analysis of the results showed that the clinical effect was favourable in 92 percent of the patients. The bacteriological efficacy amounted to 65.2 percent. The index of the isolates susceptibility was high (72 percent at the average). The concentration of cefpiramide in the bile from the bile common duct was low (23 micrograms/ml) as a result of its partial or complete obstruction. The adverse reaction (diarrhea) was stated in 1 patient.

[Effectiveness of pefloxacin in the surgical clinic]. / Effektivnost' pefloksatsina v khirurichesko i klinike.

Pefloxacin (Rhone-Poulenc, France) was used prophylactically and therapeutically in 8 and 21 surgical inpatients respectively. The majority of the Enterobacteriaceae isolates were susceptible to pefloxacin (91 to 100 per cent). The isolates of Acinetobacter spp. and Pseudomonas aeruginosa were less susceptible (77 and 33.3 per cent respectively). The isolates of Staphylococcus aureus and S. epidermidis were mainly susceptible to the drug. The high antimicrobial activity of pefloxacin used therapeutically well correlated with the favourable time course of the main disease. When pefloxacin was used prophylactically the results were positive in all the cases. The drug tolerance in the majority of the cases was good. Only 2 patients developed allergic reactions as multiple minipunctate rash. After discontinuation of the drug use and short-term course of the desensitization the clinical sings of the allergic reactions disappeared in 3 days.