[Current status of the treatment of purulent bacterial meningitis]. / Attaulità sul trattamento delle meningiti purulente batteriche

There are several stages in the management of purulent bacterial meningitis: anti-infective measures, respiratory resuscitation, treatment of mechanical neurological complications, sepsis and shock. The way in which ordinary antibiotics cross the blood-brain barrier is described, together with the anti-infective treatment of choice applicable to different aetiologies. A series of cases is presented. It is felt that, in spite of the positive influence exerted by antibiotics, the treatment of purulent bacterial meningitis is still a complex matter. In addition to careful selection of a drug against infection, rational use must be made of various forms of treatment to prevent respiratory infufficiency, neurological complications, sepsis and shock.

[Bacterial meningitis]. / Le meningiti batteriche.

After a presentation of purulent and liquoral bacterial meningites with an examination of their pathogenesis, a personal case series is presented. Particular attention is paid to the liquoral transfer of antibiotics and it is considered that the treatment of purulent bacterial meningitis cannot be standardised. In contrast tubercolar meningitis can be subjected to standardised treatment. Currently the results obtained in the treatment of purulent bacterial meningitis are less satisfactory than those obtained in tubercular meningitis though certainly better than in the recent past.

[Brucellosis therapy]. / Terapia della brucellosi.

The reasons for the use of a fat-soluble drug with an in vitro activity against Brucella spp in the treatment of brucellosis are presented. After a review of the literature a series of 222 cases subjected to various treatments is presented and it is concluded that an RMV-minocycline association offers the best antibacterial and kinetic characteristics.

[Antimicrobial therapy]. / Considerazioni sul trattamento antimicrobico.

The Authors expose the bases of a rational antibiotic therapy according to their experience. They underline the risk of using antibiotics in situations in which they are not strictly necessary. They point out the importance of the dosage, the route of administration, the frequency of doses, the length of treatment and the control of seric drug levels of aminoglycosides, in case of creatinine clearance under 50 ml/min. They shortly review the different antibiotic combination.

[Pneumococcal infections]. / Infezioni da pneumococco.

Current knowledge of the morphology, biochemistry and function of streptococcus Pneumoniae, the immune response of the host to infection and certain epidemiological aspects of pneumococcus infections is described. Personal experience of acute infections of the lower respiratory ways and meninges is presented and therapeutic problems are discussed. In Italy at least it appears that betalactamine antibiotics are preferable. Brief reference is made to the value and limitations of anti-pneumococcic vaccination.

[Comparative study, on healthy volunteers, of the bioavailability of 2 pharmaceutical formulations of oral cofosfolactamines. Trials between subjects]. / Studio comparativo su volontari sani della biodisponibilità di due formulazioni farmaceutiche di una cofosfolattamina orale: Esperienza entro soggetti.

The relative bioavailability of two drug-product formulations, aqueous suspension and tablets, of a fixed-dose combination of fosfomycin with amoxicillin (cophosfolactamine) has been comparatively studied in five healthy volunteers by means of a randomized within subjects experimental design. The plasmatic concentrations were consistent with the in vitro synergistic effects. The liquid formulation has a significantly higher bioavailability than that of the tablets.

[Cefixime. Microbiologic, kinetic and clinical profile]. / Cefixime. Profilo microbiologico, cinetico e clinico.

The microbiological, kinetic and clinical profile of cefixime, a IIIrd generation cephalosporin, administered orally, is presented. Cefixime is highly active versus Gram-negative aerobic bacteria while, with respect to Gram-positive bacteria, it is only active against Str. pneumoniae, Str. pyogenes, Str. agalactiae, and Str. bovis. It has no action against anaerobics. Endowed with good kinetics, cefixime possesses a favourable tissue distribution. Cefixime is highly indicated in infections of the upper and lower airways where the aethiology is prevalently due to Str. pneumoniae, H. influenzae and B. catarrhalis, that are extremely sensitive to the antibiotic. It is concluded that the therapeutic armamentarium has been enriched by a new, highly active antibiotic that, administered in a monodese/die, ca satisfy patient compliance.

[Changes in the phagocytic activity of human polymorphonuclear neutrophils induced in vitro by cefotiam vs 6 other antibiotics]. / Modifiche della attività fagocitaria dei polimorfonucleati neutrofili umani indotta in vitro da cefotiam vs altri 6 antibiotici.

The variation of granulocyte phagocytosis after antibiotic treatment has been studied. The conclusion is drawn that cephalosporins, piperacillin and aztreonam cause an increase of phagocytosis, while rifampicin and gentamicin induce a decrease of this activity.

[Secretory IgA. Recent progress]. / IgA secretorie. Recenti acquisizioni.

After a brief introduction on the role of the immune system, the paper illustrates the methods of IgA production and their local protective functions. Those pathologies in which the monitoring of IgA levels plays a diagnostic and prognostic role are also described. In conclusion, the current methods used for the correct evaluation of IgA2 titres are discussed: RIA and competitive immunoenzymatic and immunofluorescent tests, although the latter can only be used on biopsy tissue.

[Controlled trial with ACTH and corticosteroids in patients with cholestatic viral hepatitis]. / Ricerca controllata con ACTH e corticosteroidi in pazienti affetti da epatite virale ad impronta colostatica

Comparison was made between synthetic ACTH (tetracosactide), betamethasone and a normal paradigm (dietary management with glucose solutions, detoxicants and vitamins) over a period at least of 21 days in 27 patients with cholostatic viral hepatitis. Assessment of the clinical and laboratory parameters by means of both covariance and multivariance analysis showed that hormonal therapy offered no significant advantages with respect to the basic treatment protocol.

[Pharmacokinetic and clinical research on a new aminoglycoside antibiotic: sisomicin]. / Ricerca farmacocinetica e clinica su un nuovo antibiotico aminoglicosidico: sisomicina.

Results obtained with sisomycin in 10 cases of purulent meningitis and 4 of bronchopulmonitis showed good tissue diffusion, together with CSF concentrations sufficient to inhibit the main aetiological agents in these forms: MIC 0.02 mg/ml for both D. pneumoniae (I-ATCC 6301) and N. meningitidis (C-ATCC 13101), i.e. liquor transfer of the antibiotic more than sufficient to handle these agents.

[Pharmacokinetics of a new aminoglycoside: kanendomycin]. / Farmacocinetica di un nuovo aminoglicoside: kanendomicina.

The pharmacokinetics of kanendomycin, a new aminoglycoside derived from kanamycin, has been assessed in 15 volunteers after i.m. administration of 100 and 300 mg and i.v. administration of 100 mg. Analysis of the tricompartmental model adopted for the pharmacokinetic study showed that kanendomycin half-life is similar and perhaps superior to that of gentamycin. The antibiotic's bioavailability is of the order of 70-80% of the dose used.

[Bacampicillin vs amoxicillin in respiratory pathology]. / Bacampicillina vs amoxicillina in patologia respiratoria.

Clinical research was conducted to evaluate the comparative therapeutic efficacy in respiratory pathology of 800 mg X 2 per diem bacampicillin v. 1000 mg X 2 per diem amoxicillin, both orally administered. The results were more or less identical and are interpreted as indicating the better constant absorption of the precursor, hence its higher concentration gradient that produces a higher antibiotic concentration in the lungs.

[Pharmacokinetic and clinical research on a new antibiotic combination (amoxicillin and flucloxacillin in equivalent-weight dose)]. / Ricerca farmacocinetica e clinica su una nuova associazione antibiotica (amoxicillina e flucloxacillina in dosi equiponderali)

A controlled double-blind biometric and an open clinical trial were conducted to determine the therapeutic effectiveness of a new equal-dose w/w association of amoxicillin and flucloxacillin. The following conclusions were drawn. Both antibiotics were present in high serum levels; those of flucloxacillin were higher and more persistent. Analysis of variance on 89 patients pointed to the superiority of the association by comparison with amoxicillin alone. The clinical study made it clear that the broad and complementary spectrum of the association, its synergy, absence of toxicity and good gastric tolerance make it a valuable and effective therapeutic aid, also in presence of germs that produce beta-lactase.

[Pharmacokinetics and clinical aspects of a new ampicillin]. / Farmacocinetica e clinica di una nuova ampicillina

The chemical, physical, kinetic features, spectrum and clinical employment of amoxicillin (alpha-amino-p-hydroxbenzylpenicillin) are described. A kinetic study on 48 volunteers indicated its rapid gastroenteric absorption. In addition, the new drug quickly reached serum levels that were able double those obtained with corresponding ampicillin doses of equal weight. A very satisfactory therapeutic response and no more than trivial side-effects were noted in a clinical trial on 106 patients, most of whom presented bacterial infection of the upper and lower airways.

[Pharmacokinetic and clinical evaluation of cefoxitin]. / Valutazione farmacocinetica e clinica della cefoxitina.

An investigation conducted on healthy volunteers showed that cefoxitin quickly reaches high plasma concentrations, and is almost completely excreted via the urine within 6 hours. In a series of 21 cases treated with 2 g i.v. in 100 ml of a 5% glucose solution two or three times a day, a clinical cure was achieved in 20, and marked improvement in the remaining patient.

[Chronic hepatitis caused by B virus (HBV)]. / Le epatiti croniche da virus B (HBV).

Following a short review of the viruses underlying viral hepatitis and those which, as a secondary factory in the clinical picture, may cause fleeting liver damge, the subdivision of chronic hepatitis conditions on histopathological bases is described. Particular attention is paid to pathogenesis, with a study of the elimination of B virus, correlated to particular histopathological types. A series of 27 PCH and 49 ACH cases is reported. Of special significance was the observation of 14 ACH out of 17 biopsied drug addicts. The therapeutic problem of chronic hepatitis is then tackled.

[Pharmacokinetics and clinical studies of a new cephalosporin: cefamandole nafate]. / Farmacocinetica e clinica di una nuova cefalosporina: cefamandolo nafato.

The results of a pharmacokinetic and clinical study of cephamandol naphate indicated that the drug quickly reaches high plasma concentration after both i.m. and i.v. bolus administration. Urinary excretion of the biologically active form is as much as 84--90% of the total dose and mostly takes place in the first 6 hr. The therapeutic response was good: clinical cure in 90%, marked improvement in 6.6%, no change in 3.3%.

[Pharmacokinetics of intravenous rifampicin (RMP) and its clinical evaluation in purulent bacterial meningitis]. / Farmacocinetica della rifampicina (RMP) per via venosa e sua valutazione clinica in corso di menmingite purulenta batterica.

A combined kinetic and clinical study showed that rifampicin displays good tissue diffusibility, though it may have a tendency to accumulate. A liquor transfer sufficient for the bacteria most commonly responsible for meningeal inflammation was observed; 15/18 cases of purulent bacterial meningitis treated were clinically cured without sequelae, while 1 displayed considerable improvement. Two patients died from unforseen, uncontrollable complications that were not related to administration of the drug.

[Kinetic and clinical study of bacampicillin]. / Ricerca cinetica e clinica sulla bacampicillina.

A mean plasma concentration curve, with peaks within the first hour and moderate individual variations, was obtained after a single administration of 800 mg of bacampicillin to 5 healthy volunteers. An adequate antibiotic transfer from the circulation to the bronchial apparatus was demonstrated. Treatment of 34 patients suffering from ampicillin-sensitive bacterial diseases permitted clinical cure of all patients, without onset of side-effects. It is concluded that bacampicillin is preferable to oral ampicillin because of its kinetic and tolerance features.