Antimicrobial susceptibility of Streptococcus pneumoniae isolated from pediatric carriers in Spain.

The in vitro activity of several beta-lactam agents, macrolides, and cotrimoxazole was investigated against 53 Streptococcus pneumoniae isolates recovered from healthy children. The rates of resistance to penicillin or amoxicillin, cefaclor, and cefuroxime were 30%, 51%, and 37%, respectively. No cefotaxime-resistant isolates were found. Rates of resistance to erythromycin, clarithromycin, and cotrimoxazole were 22.6%, 13.2%, and 83%, respectively. Pneumococci with divergent antimicrobial susceptibility profiles (susceptible or moderately resistant vs. resistant isolates) coexisted in 32% samples, with divergencies more often involving beta-lactam agents and/or macrolides. In five of these samples, isolates belonged to different serotypes.

[Activity of erythromycin and clarithromicin against isolates of Streptococcus pneumoniae with decreased sensitivity to penicillin obtained from healty carriers. Spanish Collaborative Group]. / Actividad de eritromicina y claritromicina frente a aislados de Streptococcus pneumoniae con sensibilidad disminuida a la penicilina obtenidos de portadores sanos. Grupo Colaborador Español.

BACKGROUND: Empirical treatment of pneumococcal upper and lower respiratory infections must be chosen on the basis of the susceptibility patterns of nasopharyngeal colonizing strains isolated from healthy carriers. METHODS: The susceptibility to erythromycin and clarithromycin was investigated by a conventional microdilution method among 103 pneumococci isolates recovered from healthy children (n = 63) and adults (n = 40) exhibiting decreased susceptibility to penicillin (MIC > or = 0.12 mg/l). RESULTS: 63% of penicillin -resistant pediatric isolates were susceptible to erythromycin and 78.9% were susceptible to clarithromycin . Among isolates with diminished susceptibility to penicillin , 77.7% were susceptible to erythromycin and 86.3% to clarithromycin . 90% of adult isolates were susceptible to erythromycin and to clarithromycin . Overall, clarithromycin exhibited a better activity than erythromycin . CONCLUSIONS: Clarithromycin , and to a lesser extent erythromycin , are good alternatives to penicillin in the empirical treatment of respiratory tract infections caused by pneumococci with diminished susceptibility to penicillin .

Comparative in vitro activity of clarithromycin. Spanish Collaborative Group.

The activity in vitro of clarithromycin, a new macrolide, was compared to that of various antibiotics in tests using 3,880 clinical isolates. Clarithromycin was two times more active than erythromycin against Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, streptococci of groups C, G and F, Brucella melitensis, Legionella pneumophila and Mycoplasma spp., 16 times more active against Ureaplasma urealyticum and 2 to 4 times less active against Campylobacter spp. In general, clarithromycin showed intrinsic activity 2 to 4 times higher than that of roxithromycin and 4 to 8 times higher than that of miocamycin. Cross-resistance was found between the macrolides. Clarithromycin was bactericidal against Streptococcus spp. and Haemophilus influenzae.

[Hospitalizations because of drugs: a prospective study]. / Hospitalizaciones motivadas por fármacos: un estudio prospectivo.

A study was carried out during five months in La Paz Hospital with the objective to know the proportion of admissions due to an adverse reaction to pharmaceutical drugs (RAM) or due to an acute drug intoxication. For this purpose the reports of all patients seen at the Medical Emergency Room were analyzed on a daily basis. Out of 1,847 patients who needed hospital admission during this time period, 88 (4.8%) were considered to need so due to RAM or an acute intoxication. Out of 145 acute intoxications treated, 16 patients (0.9% of total admissions) had to be hospitalized. RAM constituted 3.9% of admissions, with upper GI tract hemorrhages the most frequent cause (62.5%; 72 cases). The groups of drugs responsible in most RAM were the analgesics and NSAIDs, in particular acetylsalicylic acid, followed by hypoglycemic drugs and digoxin.

Sodium-dependent and sodium-independent nicotine-evoked catecholamine release from cat adrenals.

Cat adrenal glands were stimulated with nicotine under Na-free conditions; subsequently, Na was gradually introduced as a continuously increasing gradient from 0 to 134 mM. With this experimental approach two catecholamine secretory peak responses were obtained: one was Na-independent and the second was dependent of this cation. This second response was greater in magnitude than the first and selectively blocked by (+)PN200-110, a potent dihydropiridine Ca channel blocker. The results suggest that Na, although not essential to evoke some degree of secretion, plays, however, a prominent role in amplifying the nicotine-secretory response by causing cell depolarization and opening of voltage-dependent Ca channels.

[Adverse reactions to drugs as a reason for consulting the emergency service of a general hospital]. / Las reacciones adversas a medicamentos como un motivo de consulta al servicio de urgencias de un hospital general.

The reports from the emergency service of La Paz General Hospital were daily reviewed for 4 months to investigate the number of consultations which, on the judgement of the physician on care, were due to adverse reactions to drugs. An overall number of 11,326 patients consulted. In 438 (3.9%) it was considered that the consultation was due to one or more definite, likely or possible adverse drug reactions. In 69 patients (15.8%), the reactions were considered to be severe, and 54 (12.3%) required admission; 59 reactions (13.4%) were moderate, and 310 (70.8%) were mild. The most common localizations were the skin and its appendages (37.7%) and gastrointestinal tract (25.3%). The most commonly implicated pharmacologic groups were analgesic and non-steroidal anti-inflammatory drugs (33.6%) and antimicrobials (22.1%). The incidence of adverse reactions was significantly higher in women (4.4% vs 3.3% in males, p less than 0.01). Depending on the age groups (14-29, 30-59, greater than or equal to 60 years) the incidence of nonallergic adverse reactions was significantly higher in patients aged 60 years or more (1.5%, 2%, 2.9%; chi 2 = 15.2, gl = 2, p less than 0.001). In presumably allergic adverse reactions, the incidence was significantly higher among those under 30 years (2.9%, 2.2%, 0.5%; chi 2 = 50.2; gl = 2, p less than 0.0001). The incidence of severe adverse reactions was significantly higher in patients over age 60 years (0.2%, 0.6%, 1.2%, chi 2 = 29.2, gl = 2, p less than 0.001). In 32% of cases the adverse reactions might have been prevented.

Catecholamine release evoked by lithium from the perfused adrenal gland of the cat.

The effect of Li on catecholamine release by cat isolated retrogradely perfused adrenal gland was investigated. Replacement of Na (119 mM) by Li in the Krebs solution evoked a progressive increase in the spontaneous release of catecholamines that reached a maximum within 45 min and was Ca-dependent. This response was specific for Li, since sucrose or choline used as osmotic substitutes for Na, failed to increase the spontaneous release of catecholamines by the adrenal gland. In glands perfused with Li-Krebs for 30 min a sharp secretory response was observed when Li was replaced by sucrose or choline; no such an effect was seen when Li was replaced by Na. Partial replacement of Na by sucrose, in ouabain (10(-4) M, 10 min) pretreated glands perfused with normal Krebs induced a sharp increase in the catecholamine output whilst replacement by Li produced a significantly lower response. Reintroduction of Ca (2.5 mM, 2 min) in glands previously perfused with Ca-free, Mg-containing Li-Krebs, evoked a sharp increase in catecholamine release. No such an effect was seen when the glands were perfused with Ca-free normal, choline- or sucrose-Krebs. The release of catecholamines evoked by Ca reintroduction in glands previously perfused with Ca-free Li-Krebs was directly dependent on the Li concentration and the length of time of the Li loading period. In summary, our results indicate that Li accumulates in the cells and can partially substitute Na in the Na-Ca counter-transport system at the plasma membrane of the chromaffin cell.