Cryptococcal meningitis. A review of 32 years experience.

This study is a review of cryptococcal meningitis in Queensland, Australia, with particular reference to changes in incidence, methods of diagnosis and treatment and their effects on mortality and morbidity over the past three decades. Cryptococcal meningitis remains more prevalent among males, and aborigines. Mortality has declined dramatically since 1948, due to the use of the specific antifungal agents amphotericin B, flucytosine, and more recently miconazole. The availability of cranial computerized axial tomography and the early treatment of hydrocephalus have significantly contributed to the overall management of these patients. 75% of patients receiving a full course of treatment can now be expected to make a satisfactory recovery.

Effect of hemorrhagic shock on cefazolin and gentamicin pharmacokinetics in dogs.

The physiologic response to traumatic injury may alter the disposition of drugs and thereby affect their therapeutic or toxic potential. A study was conducted in 10 mongrel dogs to determine the effect of experimental hemorrhagic shock with resuscitation on the pharmacokinetics of gentamicin and cefazolin. Single simultaneous intravenous doses of gentamicin (3 mg/kg) and cefazolin (25 mg/kg) were administered to each animal on an initial study day, after which serial blood and urine collections were performed. After 1 week, a standard hemorrhagic shock model was applied to each animal. Shock was continued for 1 h, after which the animal was resuscitated with either whole blood or saline. After stabilization for 20 min, a second dose of gentamicin and cefazolin was administered, and blood and urine were again collected. Drug clearance was not significantly altered, except for that of cefazolin after saline resuscitation, for which there was a significant increase in drug clearance. After both methods of resuscitation an increase in the volume of distribution was noted for cefazolin and gentamicin. Drug half-life was noted to be increased after shock for cefazolin by both resuscitation methods and for gentamicin after shock by saline resuscitation. Although alterations of pharmacokinetic parameters were noted, mean concentrations of gentamicin and cefazolin in serum were similar for pre- and postshock phases.