Effects of prophylactic antibiotic therapy with mezlocillin plus sulbactam on the incidence and height of fever after severe acute ischemic stroke: the Mannheim infection in stroke study (MISS).

BACKGROUND AND PURPOSE: Fever after stroke is a strong predictor for a negative outcome with infections as the most common cause. The aim of this pilot study was to evaluate the effects of prophylactic antibiotic therapy on the incidence and height of fever after acute ischemic stroke. METHODS: This is a randomized, controlled study of antibiotic prophylaxis in patients with ischemic stroke enrolled within 24 hours from clinical onset who presented bedridden (modified Rankin score >3) with no significant infection. Interventions included prophylactic mezlocillin plus sulbactam (3 x 2 g/1 g for 4 days) or conventional management. Over 10 days, body temperature was continuously monitored, and the presence of infection was daily assessed. Primary end points were incidence and height of fever; secondary end points included rate of infection and clinical outcome. RESULTS: Sixty patients were included (mean, 75 years; median National Institutes of Health Stroke Scale score, 16). Over the first 3 days, patients in the intervention group showed lower mean body temperatures as well as lower daily peak temperatures (P<0.05). Throughout the observation period, 15 of 30 patients in the intervention group but 27 of 30 patients in the conventionally treated group developed an infection (P<0.05). Mean interval until the diagnosis of infection was 5.1 days in the intervention group and 3.3 days in the control group (P<0.05). Clinical outcome was more favorable in patients with prophylactic therapy (P=0.01). CONCLUSIONS: In patients with acute severe stroke, prophylactic administration of mezlocillin plus sulbactam over 4 days decreases body temperature, lowers the rate of infection, and may be associated with a better clinical outcome.

Efficacy of oral ofloxacin for single-dose perioperative prophylaxis in general surgery--a controlled randomized clinical study.

BACKGROUND: Perioperative antibiotic prophylaxis surely reduces surgical infection rate. Pharmacokinetic data of oral ofloxacin in combination with its antibacterial spectrum suggest effective protection against perioperative infection. In addition, costs, adverse effects, and induction of microbial resistance are low. Therefore we performed a controlled randomized study comparing oral and intravenous single dose prophylaxis. METHODS: A total of 61 patients undergoing colonic or pancreatic resection randomly received either a single dose standard intravenous prophylaxis or ofloxacin 400 mg and metronidazole 500 mg orally 2 h before surgery. Postoperative infections were recorded for 3 weeks. RESULTS: Groups were very well comparable regarding age, overweight, concomitant disease, type and duration of surgery, blood loss, and volume support. Infectious complications occurred in 14.8% after parenteral and 3.3% after enteral antibiotic prophylaxis. There was no difference in post-operative hospital stay. CONCLUSION: The data demonstrate that single-dose oral ofloxacin is at least as effective as a standard intravenous prophylaxis in patients with colonic or pancreatic resection. It offers significant advantages regarding costs and ease of administration.

A prospective randomized trial of ceftazidime versus netilmicin plus mezlocillin in the empirical therapy of presumed sepsis in cirrhotic patients.

Aminoglycosides are frequently used to treat sepsis in patients with liver disease. However, it has been suggested that cirrhotic patients are particularly sensitive to aminoglycoside-induced renal dysfunction. We investigated the efficacy and incidence of renal impairment with netilmicin plus mezlocillin compared with ceftazidime in 128 cirrhotic patients who required empirical treatment for sepsis. Renal impairment developed in 8 of 63 (13%) patients receiving netilmicin compared with 2 of 65 (3%) patients receiving ceftazidime (P < .05); it occurred despite regular monitoring of trough netilmicin levels. Renal impairment was present at the time of death in 1 of 13 (8%) patients treated with ceftazidime compared with 5 of 9 (56%) of the netilmicin patients (P < .05). Mortality rates were similar in the two groups (ceftazidime 20%, aminoglycoside 14%; P = NS). Renal dysfunction is significantly more frequent in cirrhotic patients treated with netilmicin but with careful attention to dosage and fluid management the clinical effect is likely to be relatively modest.

[Surgical revision of the pilonidal sinus with single shot antibiosis]. / Die operative Sanierung des Sinus pilonidalis unter Single-shot-Antibiose.

For a therapy of the pilonidal sinus there are different surgical and non-surgical methods to be found in literature. In our surgical wing 140 male patients have been operated on this disease from September 1990 to July 1992. 16 cases out of these 140 were re-operations. Using a special surgical technique we applied the excision with a primary closure under single-shot antibiosis in 139 cases. By modifying this antibiosis prophylaxis we could reach a primary success healing rate of up to 96%. A retrospective study among our patients showed a recurrence rate of 5%.

Cervicofacial actinomycosis (a case report).

Actinomycosis is now a very uncommonly diagnosed human disease. Major medical centers report approximately one case a year. The pathogenesis of actinomycosis is unclear, but trauma provides a portal of entry. The cervicofacial form is the most common and usually appears as a chronic swelling with one or more draining sinus tracts. For treatment, penicillin in high doses is suggested. This case report presents a case of cervicofacial actinomycosis in a 14 year old boy which was misdiagnosed for a long time and the treatment of the disease with mezlocillin, a new antibiotic in the treatment of actinomycosis.

Single-dose antibiotic prophylaxis in maxillofacial surgery.

The clinical efficacy of short-term antimicrobial prophylaxis with either one shot of ceftriaxone (1 g) or a course of 3 injections of a fixed combination of mezlocillin (2 g) and oxacillin (1 g) administered over 24 h was studied in a prospective randomized clinical study of 100 patients undergoing elective maxillofacial surgery. Tissue and plasma concentrations of the antibiotics were determined by high-pressure liquid chromatography in 6 tumor surgery patients from each treatment group. Statistical analysis showed the treatment group to be comparable both demographically and with respect to the types of surgery performed and the durations of the procedures. Only 1 patient in each group developed a postoperative wound infection. It is concluded that 1 g ceftriaxone given 30 min preoperatively meets the pharmacokinetic requirements for perioperative antimicrobial prophylaxis in maxillofacial surgery.

[Ultrasound-controlled percutaneous drainage of subhepatic liver abscess after conventional cholecystectomy]. / Ultraschallgeführte perkutane Drainagen von subhepatischen Leberabszessen nach konventioneller Cholezystektomie.

From February 1984 to August 1991 subhepatic abscesses were detected by ultrasound in 7 patients with fever following conventional cholecystectomy. Cholecystectomy had been performed in all these patients 6 to 27 days previously. All patients had received antibiotic prophylaxis at the time of cholecystectomy. Three of the 7 patients were at first afebrile, later on again febrile. In the remaining 4 of the 7 patients antibiotic treatment was continued in the face of persistent fever. Percutaneous catheter drainage was performed in all patients. In all of the 7 cases the subhepatic abscesses resolved completely within 10 days to 7 weeks.

[Bile composition and antibiotic excretion. Observations with T-drainage]. / Gallenzusammensetzung und Antibiotikaausscheidung. Beobachtungen an der T-Drainage.

Patients comparable in disease, therapy and serum bilirubin concentration were either treated with mezlocillin intravenously or not at all. The bile of each patient was collected either from a T-drainage or from a percutaneously placed drainage into the bile ducts. The concentrations of GGT and AP, which were liberated by destroyed liver cells, and of bilirubin and mezlocillin, which were secreted actively, were analysed. Those patients who had normal serum bilirubin concentrations had a significantly higher biliary bilirubin excretion than those with high serum bilirubin level. The maximum excretion was after 4 hours. While the biliary concentration of bilirubin decreased, the concentration of secreted mezlocillin increased. Due to destroyed liver cells those patients with pathologically elevated blood bilirubin levels had a 50-fold lower mezlocillin excretion than those with normal blood values.

[Prospective study of the clinical value of C-reactive protein in amniotic infection syndrome]. / Prospektive Untersuchung über die klinische Wertigkeit des C-reaktiven Proteins beim Amnioninfektionssyndrom.

In an open prospective investigation the median levels of C-reactive protein were determined in annormal collective. The median lies at 0.8 mg/dl in maternal serum withdrawn sub partu and in umbilical vein blood, and at 1.45 mg/dl immediately after ligation of the cord. Hopes on finding a biochemical parameter that could supply reliable information already during labour on a possible inflammatory infection in mother and child, did not materialize from the data found. Prediction of an infection of the newborn using CPR is only minimal. The most important practical information is given by the negative CRP in the umbilical vein blood. In this case the probability of an infection of the newborn is very slight. A high temperature during labour was the best predictor of the probability of endometritis puerperalis. This clinical finding, due to its specificity, is superior to CRP and the other parameters investigated.

Use of pharmacodynamic concepts in developing a cost-effective dosing method for piperacillin.

Because they were almost always used in combination with an aminoglycoside, piperacillin and mezlocillin were considered therapeutic alternatives at Hartford Hospital, a 900-bed teaching facility. To determine an appropriate comparative dose, the bactericidal activities of 5 gm of mezlocillin and 4 gm and 3 gm of piperacillin were compared. The results demonstrated that 4 gm of piperacillin possessed stronger bactericidal activity than either 3 gm of piperacillin or 5 gm of mezlocillin. Hartford Hospital has since approved an antibiotic management program using 4 gm of piperacillin every 8 hours, thereby reducing the daily cost of antibiotic therapy. The modified program offers the hospital measurable cost savings without jeopardizing the quality of care.

[Comparative analysis of mezlocillin/metronidazole and amoxicillin/clavulanic acid as "one shot" preventive antibiotic administration in colorectal interventions]. / Vergleichsanalyse von Mezlozillin/Metronidazol und Amoxicillin/Clavulansäure als "one shot"-Antibiotikaprophylaxe bei kolorektalen Eingriffen.

The prophylactic effect of intraoperative "one shot" antibiotic application in colorectal surgery was investigated. Patients were randomised and the antibiotic combination Mezlocillin/Metronidazole (group A) or Amoxicillin/Clavulamid acid (group B) was applicated in 160 patients. 111 patients were selected for the study (group A: 59; group B: 52 patients). In the postoperative course 53% (group A) and 67% (group B) of the patients developed bacterial infections. Abdominal wound healing was complicated by infection in 15% (A) and 12% (B) of the patients. A significant difference between the two groups could not be proven, 24% of all patients with documented intraoperative bacterial contamination and 10% of the patients with negative findings developed wound infections. In colorectal surgery patients are still at high risk for infectious complications. Applicated antibiotics should basically cover aerobic and anaerobic germs.

Infected bullae: a recognizable entity.

Infected bullae are seldom diagnosed. They are frequently confused with pulmonary abscess. We present a case with a characteristic evolution. Bullae were identified previous to the infection. The illness developed gradually with scanty sputum, pleuritic pain and finally a febrile illness. Fever abated 48 hours after initiating two weeks of therapy with intravenous Clindamycin and Amikacin. As it is commonly seen, radiographic resolution was slow but it was complete in 8 weeks. Recognition of infected bullae is important to avoid inappropriate diagnostic or therapeutic interventions.

Infected bullae: a recognizable entity

Infected bullae are seldom diagnosed. They are frequently confused with pulmonary abscess. We present a case with a characteristic evolution. Bullae were identified previous to the infection. The illness developed gradually with scanty sputum, pleuritic pain and finally a febrile illness. Fever abated 48 hours after initiating two weeks of therapy with intravenous Clindamycin and Amikacin. As it is commonly seen, radiographic resolution was slow but it was complete in 8 weeks. Recognition of infected bullae is important to avoid inappropriate diagnostic or therapeutic interventions

[Sulbactam in combination with mezlocillin, piperacillin or cefotaxime. Clinical and bacteriological results in the treatment of severe bacterial infections]. / Sulbactam in Kombination mit Mezlocillin, Piperacillin oder Cefotaxim. Klinische und bakteriologische Ergebnisse bei der Behandlung schwerer bakterieller Infektionen.

An open multicenter study on inpatients of 12 german hospitals was performed to investigate efficacy and safety of sulbactam in combination with mezlocillin, piperacillin or cefotaxim in severe bacterial infections. In total 155 patients were enrolled. The following infections were diagnosed: 48 lower respiratory tract infections, 66 intraabdominal infections, 34 skin/soft tissue infections including post operative wound infections and 5 complicated urinary tract infections. 55 patients received 3 daily doses of 4 g mezlocillin + 1 g sulbactam, 52 patients received 3 daily doses of 4 g piperacillin + 1 g sulbactam and 48 patients received 3 daily doses of 2 g cefotaxim + 1 g sulbactam. Antibiotics and sulbactam were administered concomitantly via intravenous short infusion. Mean duration of therapy was 8 days. Endpoints for assessment of therapeutic efficacy were cure (complete resolution of pretreatment signs and symptoms of the infection) or improvement (marked reduction or partial disappearance or pretreatment signs and symptoms, no further antibiotic therapy required) as well as eradication of pretreatment pathogens. 141 (92%) of 153 evaluable patients were successfully treated (98 cures and 43 improvements), therapy failed in 12 patients (7.8%). Success rates of the 3 sulbactam combinations were almost identical: 91% for mezlocillin/sulbactam, 92% for piperacillin/sulbactam and 93% for cefotaxim/sulbactam. 106 patients (68.4%) were also bacteriologically evaluable. In these patients 192 bacterial pathogens were isolated prior to study therapy, 55 patients had mixed infections. In 96 patients (90%) pretreatment pathogens were eradicated (180 strains = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Excretion of beta-lactam antibiotics in human parotid saliva]. / Ausscheidung von beta-Lactamantibiotika im menschlichen Parotisspeichel.

We investigated the penetration of beta-lactam antibiotics into parotid saliva after intravenous administration. Neither mezlocillin nor oxacillin could be detected in parotid saliva, but cefotaxime (CTX) and cefotiam (CTM) penetrated parotid saliva very well. While salivary CTM concentrations reached peak values (9.52 +/- 3.4 mg/l) within 30 min of the end of infusion, the highest CTX concentrations in parotid saliva (5.84 +/- 2.6 mg/l) were observed after 90 min. After 300 min the salivary CTM levels were below the limit of detection, while the mean CTX concentration even 360 min after the end of infusion was 2.27 +/- 1.23 mg/l. Both CTX and CTM achieve salivary concentrations that are inhibitory against the prevailing pathogens causing suppurative parotitis, and thus promise to be effective for the treatment of this disease. Furthermore, the excretion of comparatively high concentrations of both drugs into the mouth achieves a selective decontamination of the mucosal surfaces of the upper aerodigestive tract so that they are suitable for perioperative prophylaxis in head and neck surgery.

Adverse reactions to prolonged treatment with high doses of carbenicillin and ureidopenicillins.

Charts were reviewed for 63 patients whose chronic pseudomonas osteomyelitis was treated with high doses of extended-spectrum penicillins for prolonged periods. The incidence of untoward drug reactions was significantly higher than expected. Carbenicillin evoked adverse reactions in 22.8% of patients. However, most of these reactions were mild, and a change of drug was required in only 5.7% of cases. No adverse drug reactions were observed with cumulative doses of less than 750 g. In contrast to carbenicillin, the ureidopenicillins were associated with adverse reactions in 67.7% of patients; most reactions were moderate to severe in intensity; a cumulative dose of greater than 250 g produced adverse reactions; and discontinuation or change of therapy was required in 51.6% of cases. The main adverse reactions to both carbenicillin and the ureidopenicillins included rash, drug fever, leukopenia, eosinophilia, thrombocytopenia, and hepatic damage.