Local Application Of Antibiotics Research Articles

The intra-oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy. A review of the literature.

Although periodontitis has a multi-factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra-oral hard surfaces) and even in the oro-pharyngeal area (e.g., the sinus and the tonsils). This review article discusses the intra-oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra-oral translocation. Based on the literature, the oro-pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve "a one stage approach" of all pathologic pockets (1-stage full-mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period. For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining dentition. This more global approach offers significant additional clinical and microbiological benefits.

Diagnosis and therapy of pediatric and juvenile hematogenous osteomyelitis

Haematogen osteomyelitis is mostly found in children and adolescents. In western Europe acute haematogen osteomyelitis (AHOM) is a rare disease. This is the cause why AHOM is often diagnosed with delay. The treatment usually is an antibiotic medication and/or surgical interventions. Uncharacteristic pain of extremities in children should always consider the diagnosis of acute osteomyelitis. Investigation should include conventional X-rays, ultrasounds or MRI to prevent the spreading of infection. In cases of multifocal infection radionuclide imaging should be undergone. Differential diagnosis should always include malignant tumor. If under treatment of antibiotics the clinical signs of illness do not decrease within 24 h surgery with fenestration of the involved bone, debridement and local application of antibiotics is indicated. In unusual cases or in cases with clinical signs of AHOM but no bacteria specification a malignant tumor has to be excluded.

The therapeutic management of radiogenic oral mucositis

Acute reactions of oral mucosa are a frequent side effect of radiotherapy, which often necessitates interruption of the treatment. Marked proliferation of tumor stem cells during treatment interruptions may occur in squamous cell carcinomata, which represent the majority of tumors in the head and neck area. Hence a fatal consequence of treatment breaks may be a significant decrease in tumor cure rates. Furthermore, marked acute responses frequently result in increased late sequelae ("consequential damage"). Therefore, amelioration of the mucosal response aiming at avoiding treatment breaks and at reduction of late reactions could definitely increase the therapeutic success of radiation treatment. Various possibilities for the therapeutic management of radiation-induced oral mucositis with a symptomatic or radio- and epithelial biological background are summarized and presented systematically. A variety of prophylactic and therapeutic methods have been proposed for the management of acute radiation reactions of the oral mucosa. Frequently, their efficacy has been established for chemotherapy or in combination with other immunosuppressive treatments. Hence, systematical rather than local effects have to be considered. In general, prophylaxis of oral mucositis is mainly based on dental restoration or edentation, in combination with frequent oral hygienic measures after the meals and with antiseptic mouthwashes. Intensive personal care is recommended. The necessity of a percutaneous endoscopic gastrostoma is dependent on the status of the patient and on size and localization of the treatment area, i.e. the impairment of food uptake which is to be expected. Therapeutic intervention is restricted to local or systemic treatment of pain and local application of antimycotics and antibiotics.

Local application of antibiotics in orthopaedic infections.

Local administration of high doses of antibiotics may be done with the use of antibiotic beads. The advantages of this treatment modality would seem to outweigh the disadvantages.

Gluteoperineal Gangrene and Sciatic Nerve Palsy After Umbilical Vessel Injection

Thirteen patients with gluteoperineal necrosis of the skin and subcutaneous tissue without muscle involvement associated with palsy of the peroneal branch of the sciatic nerve were examined at the authors' institution. This syndrome was a complication after umbilical vessel catheterization for injection of medications mainly for respiratory distress and apnea. Skin and subcutaneous damaged tissues required debridement without sedation or anesthesia. Local antibiotic application and ultraviolet rays helped heal the lesions, leaving a star-like scar that did not cause cosmetic disfigurement or fistulae formation. For the residual peroneal nerve palsy with involvement of peroneal, toe extensor, and anterior tibialis musculature, the therapeutic approach initially consisted of physical therapy to the involved muscles of the foot. Surgery was required only to correct the deformity of the foot secondary to muscular deficits. In this series, the final results of the muscles involved secondary to nerve palsy were good in 4 patients, fair in 6, and poor in 3. No excellent result was noted.

Ruptured Mycotic Extracranial Carotid Aneurysm Treated by Excision, PTFE Graft Interposition, and Local Antibiotic Application—A Case Report

A very rare case of ruptured mycotic extracranial carotid aneurysm caused by Streptococcus pneumoniae is described. An eighty-one-year-old man with a painful swelling of the right side of the neck was operated upon. There was no available vein for graft interposition and no retrograde flow in the internal carotid artery. The patient was successfully treated by resection of the aneurysm, 6 mm ringed polytetrafluoro-ethylene prosthesis interposition, and preoperative and postoperative antibiotic therapy combined with local antibiotic application. Seven months after the operation the patient remains free from complications.

Infection Prophylaxis and Infection Control in Vascular Access Surgery

This review of 133 arteriovenous (AV) fistulas, created by implantation of polytetrafluoroethylene (PTFE) graft material, reports an infection rate of 16.4% in the first period from 1982 to 1985. The infection rate decreased to 5.6% in the period from 1986 to 1990. Graft infections occurred at a higher rate of 46.2% versus 20% when reoperations because of malfunction, occlusion, aneurysm, or bleeding were necessary. Graft infections can be reduced by the development of standard surgical procedures, by the local and systemic application of antibiotics, and by a careful puncture technique. The treatment of septic graft complications after primary operations resulted in a maintenance of graft function in 50%. After secondary operations the graft had to be excised in all but 1 case.

Prevention of nosocomial lung infection in ventilated patients

A comparative, prospective study was made of the incidence of infection in the lower airway (purulent tracheobronchitis and pneumonia) in long-term patients who were mechanically ventilated due to respiratory failure of noninfectious origin. Twenty-eight patients were randomly allocated into a study group (A, n = 13) in which a nonabsorbable paste containing 2% tobramycin, 2% amphotericin B, and 2% polymyxin E was administered locally to decontaminate the oropharynx, and a control group (B, n = 15) in which a paste without antibiotics was also applied to the oropharynx. We studied the effectiveness of the prophylactic technique in decontaminating the oropharynx and trachea of organisms potentially pathogenic for the respiratory system. Decontamination was successful in ten of 13 patients in group A vs. one of 15 patients in group B (p less than .001). The results demonstrated a lower rate of infection in the lower respiratory tract in the study group (three patients with tracheobronchitis and no pneumonias) than in the control group (three patients with tracheobronchitis and 11 with pneumonia), the difference between both being highly significant (p less than .001). Two (15%) patients in group B developed sepsis of pulmonary origin. None of the patients on prophylactic treatment developed this complication. Although the overall mortality was similar in both groups (group A, 30% vs. group B, 33%), we believe that infection contributed to a great extent to the death of two of five patients in group B. We conclude that nosocomial pneumonia, which is a frequent complication in critically ill patients on mechanical ventilation, could be prevented by local application of nonabsorbable antibiotics to the oropharynx.

Effects of local application of ototoxic antibiotics on cochlear potentials in guinea pigs.

The effects of neomycin, kanamycin and dihydrostreptomycin on the cochlear microphonic, the action potential of the auditory nerve and the endocochlear potential were studied in guinea pigs in which these drugs were locally administered by perfusion. These drugs suppressed the cochlear responses markedly when applied to the endolymph but were less effective when applied to the perilymph. The mechanisms of action of antibiotics on the hair cells of the organ of Corti are discussed.

Studies in Children With Impetigo

One hundred fifty children with impetigo were studied over a two-year period. Group A β-hemolytic streptococci were isolated from the skin lesions of the majority (75%) of patients. The streptococcal pyoderma strains were further classified by agglutination reactions with T-antisera, the most frequent patterns being 25/Imp.19, T-12, and 3/B3264. No predominant staphylococcal pyoderma strains were noted by phage typing. Treatment with cleansing and local application of antibiotics were effective in healing the lesions within one to three weeks. Follow-up clinical examination and urinalyses revealed one patient who developed significant hematuria of acute glomerulonephritis, an attack rate of approximately 1%.

Sensitization and local application of antibiotics on the respiratory mucous membrane.

Local application of antibiotics to the respiratory mucous membrane in the form of drops and aerosol is more and more often used. Here the question arises of sensitization of the mucosa to the penicillin, being the strongest allergenic remedy. Experimentally, we tried with aerosol to provoke the sensitization in rabbits and we observed patients who had received aerosol several times. Laboratory examinations were made in the form of basophil degranulation determinations and compared with the control group. The results are discussed.

Familial Benign Chronic Pemphigus

Three cases of familial benign chronic pemphigus (FBCP) are presented, all of which proved to have Candida albicans superimposed on typical acantholytic lesions. The persistence of lesions in warm, moist regions and the clearing of others under therapy with local application of steroid and antibiotics, led to speculation that the fungi might have been more than a coincidental finding. To test the ability of cultured C albicans to produce typical lesions of FBCP, it was applied to previously uninvolved skin of all patients, and was uniformly successful. Histopathological confirmation was also obtained. The addition of a drug capable of inhibiting C albicans , nystatin (Mycostatin), decreased but did not completely eliminate the appearance of new lesions.

Whole pancreas as an adjuvant in wound debridement

Healing of infected wounds is frequently difficult and time consuming, causing significant physical discomfort and financial losses for patients. Efforts to find a method which will facilitate healing have resulted in the local application of various antibiotics, chemicals, and enzymes. In spite of these adjuvant forms of therapy, removal of necrotic debris by mechanical means remains the most important principle in the care of infected wounds. Notwithstanding the importance of mechanical debridement, its limitations and disadvantages provide a stimulus to develop new forms of adjuvant therapy. Cavitary wounds do not always lend themselves to operative debridement. On the other hand, their treatment with irrigations and dressing changes may be insufficient even though drainage is adequate. Mechanical debridement of wounds with minimal tissue overlying bone, urethra, blood vessels, or other vital structures cannot be performed without the risk of possible exposure and damage to these tissues. Frequently, large wounds with uneven

Whole pancreas as an adjuvant in wound debridement.

Healing of infected wounds is frequently difficult and time consuming, causing significant physical discomfort and financial losses for patients. Efforts to find a method which will facilitate healing have resulted in the local application of various antibiotics, chemicals, and enzymes. In spite of these adjuvant forms of therapy, removal of necrotic debris by mechanical means remains the most important principle in the care of infected wounds. Notwithstanding the importance of mechanical debridement, its limitations and disadvantages provide a stimulus to develop new forms of adjuvant therapy. Cavitary wounds do not always lend themselves to operative debridement. On the other hand, their treatment with irrigations and dressing changes may be insufficient even though drainage is adequate. Mechanical debridement of wounds with minimal tissue overlying bone, urethra, blood vessels, or other vital structures cannot be performed without the risk of possible exposure and damage to these tissues. Frequently, large wounds with uneven

Penetration of penethamate, a penicillin ester, into the tissues of the eye.

If antibiotic treatment of an inflammation of the eye or of the adnexa is to be successful, the micro-organisms involved must be susceptible to the antibiotic, while the concentration of the latter at the site of the infection must be sufficient. Superficial infections of the eye are effectively dealt with by the local application of antibiotics. The local concentration can easily be maintained at an effective level and microbiological identifications will make it possible to choose from the many antibiotics available. Treatment of infections of the inner eye offers no such opportunities. As long as the material remains hidden in the inner tissues of the eye, bacterial identification will be impossible. Apart from this, it is a wellestablished fact that it is very difficult to bring antibiotics into the inner eye in adequate quantity. Penicillin and streptomycin, given by subconjunctival injections, are favorable exceptions. 1 But when it is necessary