RESUMO
Patients with cystic fibrosis (CF; N = 26) and with no prior history of infection with Pseudomonas aeruginosa were immunized with an octavalent O-polysaccharide-toxin A conjugate vaccine. During the next 4 years, 16 patients (61.5%) remained free of infection and 10 (38.5%) became infected. Total serum antilipopolysaccharide (LPS) antibody levels induced by immunization were comparable in infected and noninfected patients. In contrast, 12 of 16 noninfected versus 3 of 10 infected patients (p = 0.024) mounted and maintained a high-affinity anti-LPS antibody response. When compared retrospectively with the rate in a group of age- and gender-matched, nonimmunized, noncolonized patients with CF, the rate at which P. aeruginosa infections were acquired was significantly lower (p < or = 0.02) among all immunized versus nonimmunized patients during the first 2 years of observation. Subsequently, only those immunized patients who maintained a high-affinity anti-LPS antibody response had a significant reduction (p < or = 0.014) in the rate of infection during years 3 and 4. Smooth, typeable strains of P. aeruginosa predominated among immunized patients; rough, nontypeable strains were most frequently isolated from nonimmunized patients. Mucoid variants were isolated from one immunized patient versus six nonimmunized patients. These results indicate that the induction of a high-affinity P. aeruginosa anti-LPS antibody response can influence the rate of infection in patients with CF.
Assuntos
Anticorpos Antibacterianos/imunologia , Afinidade de Anticorpos/imunologia , Vacinas Bacterianas/imunologia , Fibrose Cística/imunologia , Imunização , Lipopolissacarídeos/imunologia , Infecções por Pseudomonas/prevenção & controle , Pseudomonas aeruginosa/imunologia , Adolescente , Adulto , Anticorpos Antibacterianos/sangue , Vacinas Bacterianas/administração & dosagem , Criança , Pré-Escolar , Fibrose Cística/complicações , Relação Dose-Resposta Imunológica , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/imunologia , Estudos Retrospectivos , Vacinas Conjugadas/administração & dosagem , Vacinas Conjugadas/imunologiaRESUMO
Eighty-seven patients with cystic fibrosis were admitted to hospital with an acute exacerbation of pulmonary symptoms associated with isolation of Pseudomonas aeruginosa from sputum. The patients were randomly allocated to receive intravenously administered ceftazidime (250 mg/kg/day) and amikacin (33 mg/kg/day) alone or with inhaled amikacin (100 mg twice a day). Other aspects of the 2-week treatment were constant. The two therapy groups were comparable in all aspects. At the completion of therapy, the addition of aerosolized amikacin produced temporary eradication of P. aeruginosa in 70% of the patients, compared with 41% in the intravenous therapy only group (P less than 0.02). Suppression of P. aeruginosa in sputum cultures was correlated with the amikacin sputum concentrations. However, both regimens resulted in similar improvements in clinical, radiologic, laboratory, and pulmonary function measurements, and within 4 to 6 weeks most patients were recolonized with P. aeruginosa. There was no serious toxicity or adverse effect. In patients with cystic fibrosis, the addition of aerosol aminoglycoside to systemic antipseudomonal combination therapy is not clinically beneficial.
Assuntos
Amicacina/administração & dosagem , Ceftazidima/administração & dosagem , Fibrose Cística/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Doença Aguda , Administração por Inalação , Adolescente , Adulto , Resistência das Vias Respiratórias , Amicacina/metabolismo , Amicacina/uso terapêutico , Ceftazidima/metabolismo , Ceftazidima/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Humanos , Consumo de Oxigênio , Infecções Respiratórias/complicações , Infecções Respiratórias/metabolismo , Infecções Respiratórias/fisiopatologia , Capacidade VitalRESUMO
Extrinsic perennial bronchial asthma was studied by whole-body plethysmography in 118 patients to evaluate the degree and character of functional abnormalities during the asymptomatic "interval phase" of the disease. Study patients were divided into three functional subgroups, and the efficacy of albuterol (salbutamol), a beta-2-sympathomimetic drug, on bronchial obstruction of hyperinflation was analyzed. Response to medication was best in the group with predominant bronchial obstruction without hyperinflation. In contrast, patients with hyperinflation in the presence or absence of bronchial obstruction had only partial reversibility of their pathophysiologic alterations. Hyperinflation usually causes only minor clinical symptoms but tends to develop into irreversible lung damage in the form of "loss of elastic recoil." We suggest that early diagnosis and strict medical management in patients with hyperinflation are mandatory.
Assuntos
Asma/fisiopatologia , Pulmão/fisiopatologia , Adolescente , Resistência das Vias Respiratórias , Criança , Pré-Escolar , Feminino , Humanos , Complacência Pulmonar , Medidas de Volume Pulmonar , Masculino , Pletismografia Total , Testes de Função RespiratóriaAssuntos
Melioidose/diagnóstico , Animais , Antibacterianos/uso terapêutico , Técnicas Bacteriológicas , Doenças Cardiovasculares/etiologia , Doenças do Sistema Nervoso Central/etiologia , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Leptospirose/diagnóstico , Malária/diagnóstico , Melioidose/complicações , Melioidose/tratamento farmacológico , Melioidose/microbiologia , Pseudomonas/isolamento & purificação , Sepse/diagnóstico , Tuberculose Pulmonar/diagnóstico , Febre Tifoide/diagnósticoRESUMO
Moxalactam, a new parenteral 1-oxa-beta-lactam antibiotics, is highly effective in vitro against gram-negative enteric bacilli, including isolated from neonates with meningitis. Studies with moxalactam in experimental coliform meningitis demonstrated favorable penetration, bioavailability, and antibacterial activity in CSF. The potential value of moxalactam for therapy of gram-negative enteric meningitis of infancy prompted this study. Pharmacokinetics of moxalactam were determined in 74 infants and serum concentration-time curves were characterized bay the two-compartment open-system kinetic model. The mean peak serum concentration at the end of 50 mg/kg, ten-minute infusions was approximately 125 micrograms/ml. Elimination half-life values correlated inversely with gestational and chronologic age. The mean half-lives were 6.2 hours in neonates less than one week of age, 4.4 hours in those one to 4 weeks, and 1.6 hours in infants one to 24 months of age. A mean CSF penetration of 30% was demonstrated after repeated doses of moxalactam in 11 infants with coliform meningitis. Thirteen neonates and two infants with gram-negative enteric bacillary infections were successfully treated with this agent. the drug was well tolerated and adverse effects were not observed. Moxalactam will be evaluated in a prospective, controlled study of gram-negative enteric meningitis by the Neonatal Meningitis Cooperative Study Group.
Assuntos
Infecções Bacterianas/tratamento farmacológico , Cefalosporinas/metabolismo , Cefamicinas/metabolismo , Doenças do Recém-Nascido/tratamento farmacológico , Abscesso Encefálico/tratamento farmacológico , Cefamicinas/farmacologia , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Meia-Vida , Humanos , Lactente , Recém-Nascido , Infusões Parenterais , Injeções Intramusculares , Cinética , Infecções por Klebsiella/tratamento farmacológico , Masculino , Meningite/tratamento farmacológico , Moxalactam , Infecções por Salmonella/tratamento farmacológico , Serratia marcescens/efeitos dos fármacosAssuntos
Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus/efeitos dos fármacos , Vancomicina/farmacologia , Criança , Esquema de Medicação , Resistência Microbiana a Medicamentos , Feminino , Meia-Vida , Humanos , Lactente , Recém-Nascido , Cinética , Masculino , Vancomicina/sangue , Vancomicina/uso terapêuticoRESUMO
The medical and surgical therapy of 82 cases of atypical mycobacterial adenitis from Dallas and 298 cases from the literature was reviewed. The 92% cure rate in 149 patients with total surgical excision alone was comparable to the 95% cure rate in 156 patients when excision was followed by antituberculous drug therapy. With incision and drainage in 63 patients the cure rate was 16% whether drugs were given or not. Ten patients were initially treated with antituberculous drugs alone and only one was cured. It is concluded that total surgical excision is definitive therapy for this disease and that antituberculous drugs should be used only when surgery cannot be performed or when complete excision is not possible.