Bloodstream infections in late-stage acquired immunodeficiency syndrome patients evaluated by a lysis centrifugation system.

Opportunistic infections, which affect acquired immunodeficiency syndrome (Aids) patients, are frequently disseminated and may cause bloodstream infections (BSI). The aim of this study was to evaluate the main causes of BSI in Aids patients with advanced stage of the disease, with special emphasis on the identification of fungemia. During a 21 months period, all patients with Aids (CD4 < 200) and febrile syndrome admitted to 3 university hospitals were systematically evaluated. For each patient presenting fever, a pair of blood cultures was collected and processed by using a commercial lysis-centrifugation system. One hundred and eleven patients (75 males) with a mean age of 36 years (median 33 years) and mean CD4 count of 64 cells/ml were included. Among the 111 patients evaluated we documented 54 episodes of BSI, including 46 patients with truly systemic infections and 8 episodes considered as contaminants. BSI were caused by gram-positive bacteria (43%), fungi (20%), gram-negative bacteria (15%), mycobacteria (15%), and mixed flora (7%). The crude mortality rate of our patients was 39%, being 50% for patients with BSI and 31% for the others. In conclusion, BSI are a common related to systemic infections on Aids patients with advanced stage of disease and is associated with a high rate of mortality.

Bloodstream infections in late-stage acquired immunodeficiency syndrome patients evaluated by a lysis centrifugation system

Opportunistic infections, which affect acquired immunodeficiency syndrome (Aids) patients, are frequently disseminated and may cause bloodstream infections (BSI). The aim of this study was to evaluate the main causes of BSI in Aids patients with advanced stage of the disease, with special emphasis on the identification of fungemia. During a 21 months period, all patients with Aids (CD4 < 200) and febrile syndrome admitted to 3 university hospitals were systematically evaluated. For each patient presenting fever, a pair of blood cultures was collected and processed by using a commercial lysis-centrifugation system. One hundred and eleven patients (75 males) with a mean age of 36 years (median 33 years) and mean CD4 count of 64 cells/ml were included. Among the 111 patients evaluated we documented 54 episodes of BSI, including 46 patients with truly systemic infections and 8 episodes considered as contaminants. BSI were caused by gram-positive bacteria (43 percent), fungi (20 percent), gram-negative bacteria (15 percent), mycobacteria (15 percent), and mixed flora (7 percent). The crude mortality rate of our patients was 39 percent, being 50 percent for patients with BSI and 31 percent for the others. In conclusion, BSI are a common related to systemic infections on Aids patients with advanced stage of disease and is associated with a high rate of mortality

Perfil farmacocinético de três diferentes doses diárias de amoxicilina / Pharmacokinetic profile of three different daily dosages of amoxicilin

Apesar da amoxicilina ser largamente prescrita na prática clínica há décadas, estudos recentes têm mostrado que ela é ainda um antibiótico bactericida muito ativo e clinicamente mais efetivo que outros antibióticos betalactâmicos orais. Preparados numerosos contendo amoxicilina estäo disponíveis no mercado e näo há um consenso a respeito de sua apropriada dose diária. O objetivo deste estudo foi de assegurar os parâmetros farmacocinéticos da amoxicilina dada em três diferentes doses diárias, a fim de oferecer uma recomendaçäo relacionada ao seu uso clínico. Foram oferecidos a doze voluntários três regimes diferentes de doses orais de amoxicilina por 24 horas, de acordo com um ensaio aberto, randomizado, cruzado. As concentraçöes de amoxicilina no plasma foram medidos pelo HPLC por 24 horas. A área sob a curva de amoxicilina de 0-24 horas foi significativamente maior com 2.0 g de 12/12 horas que com os outros dois regimes de doses. Níveis plasmáticos de amoxicilina estavam acima das concentraçöes inibitórias mínimas para a maioria dos patógenos suscetíveis, ficando em torno de 90 porcento do tempo com regimes de 1,0 g de 8/8 horas e 2,0 g de 12/12 horas versus em torno de 80 porcento do tempo com a dose de 1,5 g de 12/12 horas.(au)

New cyclosporine microemulsion randomized, cross-over bioequivalence steady-state study in renal transplanted patients.

A new microemulsion formulation of cyclosporine was compared with the marketed formulation in 18 stable renal transplanted patients. Aim of the study was not only to determine the bioequivalence between the two pharmaceutical preparations, but also to ascertain whether tested drug could maintain stable blood concentrations of cyclosporine. Renal transplanted patients under cyclosporine treatment from at least 12 months at a well individualized dosage (resulting in 90-200 ng/mL of blood level drug) have been selected. Patients received the same preceding dose of cyclosporine through both the two preparations according to a cross-over, randomized schedule during 4 weeks in two equally divided daily administrations. Serial blood samples were obtained over a 24-hour period at steady-state of each formulation. Cyclosporine concentrations were determined by a specific immunoassay method (FPIA) n whole blood taken in the last day of each cycle of treatment. Statistical comparisons of cyclosporine levels (using pharmacokinetic parameters) were cross-performed between formulations and days of blood test. Tested drug resulted bioequivalent with the reference marketed formulation. Furthermore, the study showed that tested drug maintained satisfactory stable blood concentrations of cyclosporine.

Novas penicilinas e cefalosporinas. / New penicillins and cephalosporins

E feita uma revisao sobre novas penicilinas e cefalosporinas ja introduzidas na pratica medica ou ainda em fase de avaliacao clinica. Entre as penicilinas, sao analisados os esteres da ampicilina (pivampicilina, talampicilina e bacampicilina), os esteres da carbenicilina (indanilcarbenicilina, e carfecilina), os derivados da carbenicilina (ticarcilina e temocilina), os derivados da ampicilina (piperacilina e apalcilina) as ureidopenicilinas (mezlocilina e azlocilina) e as amidinopenicilinas (mecilinam e piv-mecilinam). Entre os antibioticos beta-lactamicos nao-penicilinicos e nao-cefalosporinicos, sao estudados a tienamicina, a N-formimidoiltienamicina e o moxalactam, e entre os monobactamicos, o aztreonam.Sao tambem analisadas as principais caracteristicas das novas cefalosporinas,particularmente as de segunda gera cao (cefamandol, cefuroxima e cefoxitina)e as de terceira geracao (cefotaxima, cefoperazona ceftriaxona, cefmenoxina, ceftizoxima, ceftazidima, cefsulodina e cefotetana

Emprego de antibioticos em associacoes. / Use of antibiotic combination

E feita uma revisao sobre o emprego de antibioticos em associacao. Analisam-se os conceitos de sinergismo, antagonismo e indiferenca, e descrem-se os requisitos que devem ser atendidos para que a indicacao seja fundamentada. Relatam-se as multiplas situacoes clinicas em que esta indicada essa conduta e os diversos tipos de associacos de antibioticos utilizados na praciacoes de antibioticos utilicados na pravenitentes do uso de antibioticos em assovenientes do uso de antibioticos em assobasicas gerais para a indicacao correta de associacoes de antibioticos