[ОPTIMIZATION OF TREATMENT OF THE PATIENTS, SUFFERING NEUROPATHICALLY-ІNFECTED FORM OF THE DIABETIC FOOT SYNDROME, USING THE IODINE PREPARATIONS AND LOW-INTENSIVE LASER IRRADIATION].

The changes in antibiotic sensitivity of the purulent-necrotic processes agents under the low-intensive laser irradiation impact were studied in experimental part of the investigation. There were 156 patients, suffering neuropathically-infected form of the diabetic foot syndrome, examined and treated, in 41 of them the iodine deficiency was revealed. Durable regional intaarterial infusion, low-intensive laser irradiation and preparations of iodine in a daily dose of 200 mcg were applied. High efficacy of the antibacterial therapy photomodification was proved, it have permitted to improve the results of treatment, to refuse from disabling operations in majority of the patients, to secure the foot bearing function. While the iodine deficiency presence the results of treatment are improved due to application of the iodine preparations.

Mitigation of hearing loss from semi-circular canal transection in pseudomonas otitis media with ciprofloxacin-dexamethasone irrigation.

HYPOTHESIS: Irrigation of the mastoid with a quinolone antibiotic-steroid solution may mitigate hearing loss caused by iatrogenic semicircular canal injury in the presence of Pseudomonas aeruginosa (PA) otitis media (OM). BACKGROUND: Studies have shown the cochlea to be more vulnerable to semicircular canal transection (SCT)-related hearing loss in the presence of PA OM. Prophylactic systemic antibiotics and steroids may decrease this hearing loss, but SCT is usually not planned. The aim of this study was to determine if irrigation with ciprofloxacin-dexamethasone (cipro-dex) could improve hearing outcomes following SCT in PA OM. METHODS: PA OM was induced in 28 animals. After three to five days, unilateral SCT was performed in each animal, with sham SCT on the contralateral ear. At surgery, half of the animals (n = 14) underwent irrigation of the both mastoid bullae with cipro-dex; the second group of animals (n = 14) underwent irrigation of the bullae with sterile saline. Auditory thresholds were obtained immediately prior to SCT and 7-10 days after SCT. RESULTS: SCT ears treated with cipro-dex showed a mean click threshold improvement of 4.6 dB from pre-transection to 7-10 days post-transection, whereas thresholds in the SCT ears treated with saline worsened by 7.5 dB (p = 0.15). CONCLUSION: Irrigation of the guinea pig bulla with cipro-dex following SCT in the setting of PA OM appears safe and may yield beneficial effects on hearing.

Successful treatment of malignant external otitis with oral ciprofloxacin: report of experience with 23 patients.

Twenty-three consecutive patients with malignant external otitis (MEO) were treated with oral ciprofloxacin, 1.5-2.25 g/day for 6 weeks. Treatment was combined with local surgical debridement. Patients were discharged early for ambulatory follow-up. Few minor side effects were reported, and full compliance with the study drug was observed. In 21 patients cure was achieved; in 2 the response was not adequate. Oral ciprofloxacin is an effective, convenient, nontoxic, economically justified alternative to the combination intravenous therapy previously advocated.

[Autologous spongiosa as an antibiotic carrier in the treatment of osteitis]. / Autologe Spongiosa als Antibioticumträger zur Behandlung der Osteitis.

The treatment of osteomyelitis essentially depends on a bactericidal concentration of antibiotic in bone tissue with an appropriate spectrum. Ciprofloxacin is effective against the main organisms causing osteomyelitis (staphylococcus aureus, pseudomonas aeruginosa) at low MIC. We investigated the concentration of ciprofloxacin in human bone. After a single dose (200 mg ciprofloxacin i.v., preoperatively) the concentration in cortical bone was 6.9 +/- 0.8 mcg/g and 9.7 +/- 0.8 mcg/g in cancellous bone. In any case the concentration of ciprofloxacin exceeded the MIC for staph. aureus and pseudomonas aeruginosa. For the treatment of osteomyelitis we transferred the antibiotic bound to autologous cancellous bone grafts to the site of inflammation after surgical debridement. First clinical results are documented.

Current problems in the treatment of infective endocarditis due to Pseudomonas aeruginosa.

Mortality from pseudomonas infective endocarditis remains high despite optimal use of available antibacterial agents. Infection of the tricuspid valve is subacute, but involvement of the mitral or aortic valve precipitates more serious disease. Most valvular infections are due to a single pseudomonad immunotype, but 20% of cases are mixed infections. Antimicrobial susceptibility tests and tests of synergy by beta-lactam and aminoglycoside antibiotics in combination were performed on 30 isolates of Pseudomonas aeruginosa. Azlocillin was the most effective beta-lactam in combination with an aminoglycoside; MKO 787 was least effective. Among the aminoglycosides tested, netilmicin was the most effective. Medical treatment combined with valvulectomy (without valve replacement) is now standard treatment for refractory right-sided endocarditis at this medical center. A high dose of aminoglycoside in combination with a beta-lactam has proved efficacious. For left-sided infection, immediate valve replacement accompanied by a six-week course of the high dose-combined drug regimen is recommended. Newer beta-lactam antibiotics, such as piperacillin, may be limited in usefulness due to beta-lactamase inactivation.