[Efficacy of meropenem in the treatment of severe complicated urinary tract infections]. / Effektivnost' meropenema pri lechenii tiazhelykh oslozhnennykh infektsii mochevyvodiashchikh putei.

The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. In 8 patients the drug was administered intravenously in a dose of 1 g every 8 hours and in 4 patients with the creatinine clearance below 50 ml/min it was administered in a dose of 1 g every 12 hours (the treatment course of 7 to 10 days). Meropenem was used in the monotherapy. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent.

[The rapid microbiological control of the efficacy of the antibacterial therapy of bacteremia and septicemia]. / Mikrobiologicheskii ékspress-kontrol' éffektivnosti antibakterial'noi terapii bakteriemii i septitsemii.

No previous isolation of the agent on the media is needed in using a new microbiological express-method of automatic control over antibacterial therapy of bacteremia and septicemia. The method is efficient in determination of sensitivity to the drug of the whole heterogeneous population of bacteria. It does not predict efficacy of antibacterial therapy but states the presence or absence of the effect in vivo. The method is integral, evaluates antibacterial plasma titer suggesting adequate correction. The duration of the test is maximum 12 h that is 3-4 times less than other methods.

[The etiological structure of the causative agents of inflammatory nonspecific urological diseases and the dynamics of their resistance to the widely used antibiotics]. / Etiologicheskaia struktura vozbuditelei vospalitel'nykh nespetsificheskikh urologicheskikh zabolevanii i dinamika ikh rezistentnost' k shiroko primeniaemym antibiotikam.

Of late, a trend to a marked loss in antibacterial efficacy of some antibiotics, for instance gentamycin and carbenicillin, is noted. This is due to changes in the microflora composition and sensitivity to antibiotics, an increase in the number of polyresistant microorganism strains. As gentamycin is effective now only against E. coli, it is not appropriate to use it in urological hospitals. Cefatoxim (claforan), on the contrary, retains its high antibacterial potential and becomes a basic antibiotic in the treatment of bacterial infections in urology. Continuous microbiological control is needed over fluoroquinolones microflora resistance to which is on the increase. Correction of therapy may be also required in the presence of such pathogens as Pseudomonas aeruginosa.

[The use of antimicrobial preparations in preventing infectious wound complications after an operation on the kidney and upper urinary tract]. / Primenenie nekotorykh antimikrobnykh preparatov v profilaktike infektsionnykh ranevykh oslozhnenii posle operatsii na pochke i verkhnikh mochevykh putiakh.

Pre-, intra- and postoperative use of wide-spectrum antibiotics alone appeared insufficient to prevent postoperative infectious inflammation. Antiseptic chlorhexidine (0.02% solution) does not eradicate the infection focus either. Cleansing of the wound is effective provided antibacterial treatment of the operative wound is combined with intraoperative application of local long-acting antimicrobial plates gentacicol and solution of antiseptic sodium hypochlorite. The above approach results in a 3.5 times reduction in the number of infectious postoperative complications in patients operated on the kidney and upper urethra.

[Effectiveness of cefpirome in the treatment of complicated infections of the upper and lower urinary tracts]. / Effektivnost' tsefpiroma pri lechenii oslozhnennykh infektsii verkhnikh i nizhnikh mochevyvodiashchikh putei.

Two hundred and two isolates of gram-positive and gram-negative pathogens of urinary tract infection were tested for their susceptibility to cefpirome. In 64 to 97 per cent of the cases the susceptibility was high and exceeded that of other cephalosporins used in the treatment of urological patients. Cefpirome was used in the treatment of 26 patients with signs of urinary tract infection: 19 patients with pyelonephritis and 7 patients with prostatitis. The antibiotic was administered intravenously in a dose of 1 g twice a day for the treatment course of 5-7-10 days. The clinical and bacteriological efficacies amounted to 92 and 87 per cent respectively. The drug tolerance was good. The results demonstrated that cefpirome was useful in the empirical therapy of urinary tract infection.

[The efficacy of bacteriophage preparations in treating inflammatory urologic diseases]. / Effektivnost' preparatov bakteriofagov pri lechenii vospalitel'nykh urologicheskikh zabolevanii.

Urinary infection is the most commonly encountered hospital infection. Antibacterial therapy promotes selection and dissemination of polyresistant microorganism strains, development of intestinal dysbacteriosis, reduction of intestinal contamination resistance. Clinical and bacteriological efficacy of urinary infection treatment with bacteriophage preparations (pyocyanic, proteus, staphylococcal, coliphage, combined pyobacteriophage) was studied. Sensitivity of the infective agent phage isolated from urological patients was tested before treatment. The preparations were adapted to recently isolated agents from urological patients to raise phage sensitivity of the strains. A total of 293 strains were studied. Phage sensitivity made up 68.9%. Bacteriophage preparations were used both locally and orally in 46 patients with acute and chronic urogenital inflammation. Bacteriological efficacy amounted to 84%, clinical one to 92%. It is inferred that phagotherapy is effective and safe therapeutic modality in the treatment of urinary infection in monotherapy and in combination with antibiotics.

[The use of cephmetazon in treating infectious inflammatory diseases of the upper and lower urinary tract]. / Primenenie tsefmetazona pri lechenii infektsionno-vospalitel'nykh zabolevanii verkhnikh i nizhnikh mochevyvodiashchikh putei.

A clinical trial of cephmethasone (Sankyo, Japan) has been performed in 40 patients with pyelonephritis. 3 patients with chronic cystitis. 19 patients with chronic prostatitis. Cephmethasone, cephalosporin of the second generation, is active against gram-positive and gram-negative agents, hospital infection. The treatment course consists of 4-14 daily doses of 2-4 g. Bacterial elimination was reached in 79.5% of the cases with a complete response in 70% and partial one in 30% of patients. Side effects were not registered. As a highly active wide-spectrum antibiotic, cephmethasone is offered for treatment of urinary infections. Cephmethasone monotherapy provides a rapid relief of cystitis, prostatitis and pyelonephritis symptoms.

[Lomefloxacin in the treatment and prevention of urogenital infection]. / Lomefloksatsin pri lechenii i profilaktike infektsii mochepolovykh organov.

A new antibiotic from fluoroquinolone series maxaquine (lomefloxacin) made in USA (Searle [correction of Surl]) has been tried in the treatment of urogenital infection (chronic cystitis, prostatitis, pyelonephritis, acute epididymitis, chlamydial urethroprostatitis) as well as to warrant antibacterial preparation before extracorporeal lithotripsy. The duration of the treatment course (3-28 days) was oriented to nosological form. The 24-h dose ranged from 400 to 800 mg. Side effects manifested with dyspepsia in 4 patients, worsening of memory in 2 patients. Photosensitization did not occur. Maxaquine clinical efficacy is similar to aminoglycosides and is superior to cephalosporins of the third generation. As for fluoroquinolone antibiotics, maxaquine can be compared to cyprofloxacine. The drug proved effective against urethroprostatitis and urethrocystitis of chlamydial origin. The responses to maxaquine favour its application in hospitals as second-line drug, whereas outpatiently it can be used for short-term empiric therapy.

[Effectiveness of cefmetazole in the treatment of infectious-inflammatory urologic diseases]. / Effektivnost' tsefmetazola pri lechenii infektsionno-vospalitel'nykh urologicheskikh zabolevanii.

An open non-comparative clinical trial of cefmetazole in the treatment of 40 patients with infections of the lower and upper urinary tracts was performed. The clinical results were excellent and good in 100 per cent of the cases. In 75 per cent of the cases the efficacy was bacteriological (complete eradication of the pathogen). No patients showed any adverse reactions to the treatment with cefmetazole. The general estimate of the results was indicative of the cefmetazole high efficacy in the treatment of the infections of the upper and lower urinary tracts.

[The differential microbiological diagnosis of bacteremia and sepsis and the results of its practical use]. / Differentsial'naia mikrobiologicheskaia diagnostika bakteriemii i sepsisa i rezul'taty ee prakticheskogo ispol'zovaniia.

A rapid method for the detection of classical forms of bacteria and their cell-wall defective (CWD) variants in the blood has been developed and approved. The method is based on the kinetic analysis of bacterial growth with the use of nephelometry. The analysis lasts 3-10 hours. The method permits the differential microbiological diagnosis of bacteremia and sepsis, as well as the rapid control of the effectiveness of antibacterial therapy. The rapid method has revealed that in the presence of antibacterial therapy infective agents persist in the blood as CWD variants and not in the classical bacterial form, which sharply decreases the reliability of the traditional diagnostic method. CWD variants have been detected in the blood of patients treated with the preparations of cephalosporin, chinolon, aminoglycoside, dioxydin, etc.

[The clinical efficacy of the new drug agent ligentén in urology patients]. / Klinicheskaia éffektivnost' novogo lekarstvennogo sredstva ligenténa u urologicheskikh bol'nykh.

A clinical trial was made of a new gel ligenten intended for local urethral anesthesia and treatment of infection and inflammation in the lower urinary tracts. Ligenten was given to 52 patients to manage bladder, prostate, urethral infection and inflammation, for local prophylaxis before cystoscopy, urethral bouginage and transurethral surgery. Apparent advantages of intraurethral introduction of the analgetic compared to instrument lubrication are demonstrated. Ligenten was also effective against chronic cystitis, cystalgia and urethral syndrome in females, especially in ulcerative cystitis. The gel exhibited adequate antiinflammatory and analgetic effect. As a prophylactic means, it prevents inflammation in cystoscopy, urethral catheterization and transurethral operations. No severe side effects have been reported.

[The prevention of infectious-inflammatory complications in the postoperative period in percutaneous surgical interventions in patients with urolithiasis]. / Profilaktika infektsionno-vospalitel'nykh oslozhnenii v posleoperatsionnom periode pri perkutannykh khirurgicheskikh vmeshatel'stvakh u bol'nykh s mochekamennoi bolezn'iu.

The paper describes a number of modifications in the operative procedures, pre-, intra- and postoperative antibacterial treatment introduced to decrease the number and severity of infectious-inflammatory complications of endourological surgery for urolithiasis; presents the results of anti-bacterial prophylaxis of urinary infection aggravation in 29 patients suffering from urolithiasis combined with renal anomalies. Antibacterial treatment was performed with ftorquinolone drug ciprinol (ciprofloxacin hydrochloride) made in Slovenia. 18 patients received ciprinol twice a day at a dose 500 mg 3-5 days before the operation and within 5-7 postoperative days. The other 11 patients received the drug intravenously (100 mg in drops) in parallel with initial anesthesia and during 1-2 postoperative days. It was continued orally within the next 5-6 postoperative days. The analysis of ciprinol pharmacokinetic profile showed its concentrations in the blood and urine to surpass minimal inhibitory concentration for the majority of the isolated microorganisms. Out of 18 patients treated with oral ciprinol, postoperative aggravation of pyelonephritis occurred in 3 (16.7%) versus 8 (40%) cases out of 20 controls. 11 patients on intravenous ciprinol developed no complications. The conclusion is made on high efficacy of preoperative antibacterial preparation and of intraoperative antibacterial therapy continued for some time after the surgery in cases of percutaneous endoscopic surgical interventions for urolithiasis attended by chronic urinary infection. The antibacterial treatment brings about a 2-3-fold decrease in the occurrence of postoperative inflammatory complications.

[The efficacy of Ligenten gel in the prevention and treatment of infectious-inflammatory diseases of the urogenital organs]. / Effektivnost' gelia Ligentena pri profilaktike i lecheniia infektsionno-vospalitel'nykh zabolevanii mochepolovykh organov.

A new therapeutic in the form of a gel named ligenten was studied. The gel active components are lidocain, gentamicin and ethonium. Ligenten was shown to have a marked local anesthetic action when administered transurethrally. As a prophylactic agent the gel was highly active against the majority of the causative agents of renal infections due to cystoscopy, catheterization and bougienage of the urethra. Ligenten provided a sufficient anesthetic effect in transurethral operations but did not prevent superinfection due to the hospital strains. Marked antiinflammatory and reparative actions of the gel especially in the treatment of ulcerous cystitis were observed.

[Sulbactam/ampicillin in the treatment and prevention of urologic diseases]. / Sul'baktam/ampitsillin v lechenii i profilaktike urologicheskikh zabolevanii.

Efficacy and safety of unasyn, a combination of sulbactam and ampicillin, was studied in the treatment of 66 patients with infections of the urogenital organs. The drug was administered intramuscularly, intravenously and orally. The treatment course averaged 7-14 days. The dose of the drug for the intravenous and intramuscular administration was 1.5-3 g 4 times a day and that for the oral administration was 0.75 g 2 times a day. The strains of gram-positive cocci, Escherichia coli and Proteus spp. proved to be highly sensitive to the drug: 80-83, 43 and 53 per cent of the sensitive strains respectively. 25-75 per cent of the strains showed beta-lactamase activity that was most frequently detected in Proteus spp. and Staphylococcus spp. The maximum concentrations of ampicillin and sulbactam determined by liquid chromatography were respectively 18 +/- 5.7 and 11 +/- 2.42 micrograms/ml in the blood and 700 and 350 micrograms/ml in the urine. A satisfactory bacteriological effect of the treatment was observed in 93 per cent of the cases. A complete elimination of the initial pathogens was stated in 57-73 per cent of the cases. No side effects were recorded.

[Antimicrobial activity of pefloxacin in comparison with other quinolones]. / Antimikrobnaia aktivnost' pefloksatsina v sravnenii s drugimi khinolonami.

The antibiotic sensitivity of 338 microbial cultures isolated from patients with inflammatory renal and urinary diseases was studied. 66.3 per cent of the isolates proved to be poly-resistant which corresponded to rurological patient specificity. It was shown that abactal (pefloxacin, LEK, Yugoslavia) had a higher antimicrobial activity than the nonfluorinated quinolones especially against Staphylococci and a lower antimicrobial activity than the fluorinated quinolones in vitro. The abactal sensitivity to Pseudomonas aeruginosa amounted only to 23 per cent which was likely to be due to development of cross-resistance to ofloxacin. 1/3 of the polyresistant isolates were sensitive to abactal. The activity of abactal weakly depended on the medium pH. The MBC was generally no more than 2 MICs.

[Pefloxacin pharmacokinetics in pyo-inflammatory diseases of the kidneys and urinary tract]. / Farmakokinetika pefloksatsina pri gnoino-vospalitel'nykh zabolevaniiakh pochek i mochevyvodiashchikh putei.

The factors defining the therapy efficacy were studied in 15 patients with purulent inflammatory diseases of the kidneys and urinary tract. It was found that after the use of pefloxacin, urine bactericidal properties against a pathogen was pH-dependent due to high urinary norfloxacin levels. To predict the efficacy of pefloxacin therapy in renal and urinary diseases, the pathogen should be tested for sensitivity to pefloxacin and norfloxacin within a wide range of pH values. Pefloxacin concentrations correlated with plasma bactericidal properties with respect to the pathogen and was applicable in defining the optimal treatment schemes and doses based on the data of individual drug pharmacokinetics. Monitoring of plasma and urine bactericidal properties in regard to the pathogen proved to be useful in estimating the therapy efficacy.

[Bacterial toxic shock in urological diseases]. / Bakteriotoksicheskii shok pri urologicheskikh zabolevaniiakh.

It is a review of present-day and historical aspects of bacterial toxic shock arising in urological setting. It is noted that conditions of its onset are changing, therapeutic approaches undergo revision, critical care facilities are updated. Among the causes of this complication the authors single out endoscopic procedures, transurethral interventions in the presence of infectious process, hospital infection, long stay at hospital. Forty-eight cases of bacterial toxic shock are reviewed in relation to classification, causes of development, treatment, bacteriological evaluation.

[The use of ampicillin/sulbactam (Unasyn) in treating inflammatory urological diseases]. / Ispol'zovanie ampitsillin/sul'baktama (unazina) pri lechenii vospalitel'nykh urologicheskikh zabolevanii.

Unasyn is a combination of ampicillin, a bactericidal antibiotic, and sulbactam, an inhibitor of beta-lactamases. It was used in treatment of 36 patients with urogenital infections. The combination was administered intravenously and in the main intramuscularly. The treatment course amounted to 7-10 days. The average daily dose was 6 to 9 g. 22 patients with acute nonocclusive pyelonephritis were treated with the combination and its clinical and bacteriological efficacy was stated in 95 per cent of the cases. An excellent clinical effect of the combination was observed in 6 patients with acute epididymitis. A clinical improvement was also observed in the treatment of the patients with acute prostatitis and chronic renal infections. Unasyn proved to be a highly efficient antibacterial combination with regard to gram-positive flora and colon bacilli as representatives of gram-negative organisms. Satisfactory results were also stated in the treatment of infections caused by Proteus spp. Complete elimination of the pathogen was achieved in 57.7 per cent of the cases. No adverse reactions to Unasyn except pain in the site of the injection were recorded.