Complicated Urinary Infections Research Articles

Compassionate use of norfloxacin

Norfloxacin, a new oral fluoroquinolone, has a spectrum of activity and pharmacology that suggest it may be useful in certain infections in which other agents are inactive or have anticipated toxicity. This report is an analysis of 61 “compassionate” requests for norfloxacin that resulted in 42 treatment courses. The reasons for use included multiresistant pathogens susceptible only to norfloxacin in 42 percent, failure of prior use of a marketed antibiotic in 34 percent, and preferred use of norfloxacin due to anticipated toxicity from an aminoglycoside in 32 percent or from other agents in 9 percent. Infections treated included 29 complicated urinary tract infections, 23 involving multiresistant Pseudomonas species, and 10 gastrointestinal infections, seven involving Salmonella species. Prophylaxis of infection was initiated in three neutropenic patients with leukemia. The duration of norfloxacin therapy ranged from eight to 28 days at a daily dose of 800 mg (400 mg twice daily). Norfloxacin treatment resulted in clinical cure or improvement in 84 percent of patients and eradicated the etiologic pathogen(s) 52 percent of the time. In Pseudomonas species infections, cure was achieved in 29 percent of patients and 57 percent showed improvement; the pathogen was eradicated in 43 percent of these infections. Resistance developed in four of the eight Pseudomonas species infections that persisted. Based on a review of compassionate therapy cases, it appears that norfloxacin is effective oral therapy for many complicated urinary and gastrointestinal infections for which other agents cannot be used because of bacterial resistance or anticipated toxicity.

Cefamandole and Cefazolin in the Therapy of Complicated Urinary Tract Infections

The clinical efficacy and tolerance of cefamandole, a new cephalosporin antibiotic effective against indole-positive strains of Proteus, and cefazolin were studied after intramuscular administration of 500 mg of either of the two cephalosporins every 8 hr for seven days in a prospective, randomized study of 65 elderly male patients with complicated urinary tarct infections. Both antibiotics were effective in eradicating the infections, and there was no significant difference between the two groups in regard to tolerance and cure rate, as defined by a negative urine culture one week and four to six weeks following discontinuation of the treatment. Because of its broader antibacterial spectrum, cefamandole appears to represent an improvement over previously available cephalosporin antibiotics.

RECENT ADVANCES IN THE MANAGEMENT OF SPINAL INJURIES WITH PARALYSIS

In the last decade, by application of detailed methods of care, the previously accepted complications of urinary infection, pressure sores and motor skeletal problems of contractures and spasm, have largely been eliminated from the clinical picture of patients with spinal paralysis. Many professionals in medicine have contributed to these advances. Long-term or extended care in the area of tetraplegia and paraplegia need further stimulation, with continued application of all those methods used in acute rehabilitation in properly organized spinal units.

Oxolinic Acid Therapy for Urinary Tract Infections in Children

Thirty hospitalized children with Gram-negative bacillary urinary tract infections were treated with oxolinic acid for 14 to 21 dyas. Fifteen of 17 patients with uncomplicated and 11 of 13 with complicated urinary infections had favorable bacteriologic responses. Resistant organisms developed in four treatment failures. Oxolinic acid urine concentrations were well above the minimal inhibitory concentration for most strains of Escherichia coli, Klebsiella, Enterobacter, Proteus mirabilis, P vulgaris, P morganii, and P rettgeri. Approximately half of these patients experienced mild symptoms possibly related to oxolinic acid therapy; in no instance did they require cessation of therapy. Our experience indicates that if the urine is not sterile by the end of five days of treatment, bacterial resistance to oxolinic acid is likely to have developed, and therapy with another agent should be considered and antibiotic susceptibility tests repeated.