Tags: Netilmicin

Infection in Patients With Aids

Paeruginosa infections may occur in patients with AIDS. Risk factors for infection include a CD4 count of < 100 cells/mL3, neutropenia or functional neutrophil defects, intravascular catheterization, hospitalization, and prior use of antibiotics including ciprofloxacin or trimethoprim-sulfamethoxazole. Many cases are community acquired. Bacteremia is common, and the lung or an intravenous catheter is the most frequent portal of entry. An impaired ability to mount immunotype-specific antibodies to Pseudomonas lipopolysaccharide antigen has been noted in HIV-positive individuals with bacteremia. Relapse is frequent, and mortality is high, 40%. Pneumonia is usually associated with cavitation and a high relapse rate. Bacterial sinusitis is an important and frequently undetected illness in HIV-positive individuals, and P …

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Enterococci

Essentials of Diagnosis • Gram stain shows gram-positive cocci that occur in singles, pairs, and short chains; recovery of microorganism from culture of blood or other sterile source. • Lancefield group D antigen. • Clinical isolates: Enterococcus faecalis, 74%; E faecium, 16%; other species, 10%. • Facultative anaerobes grow in 6.5% NaCl at pH 9.6 and at temperatures ranging from 10 °C to 45 °C, and grow in the presence of 40% bile salts and hydrolyze esculin and L-pyrrolidonyl-ß-naphthylamide. • Infections typically of a gastrointestinal or genitourinary origin. • The most common infections are urinary tract infection, bacteremia, endocarditis, intra-abdominal and pelvic infection, and wound and soft tissue infection. General Considerations …

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Brucellosis

Description of Medical Condition Systemic bacterial infection caused by Brucella species in infected animal products, or vaccine. Incubation period usually 5-60 days, but highly variable and may be several months. Characterized by intermittent or irregular fevers, with symptoms ranging from subclinical disease to infection of almost any organ system. Bone and joint involvement common. May be chronic or recurrent. Case fatality untreated less than 2%. System(s) affected: Endocrine/Metabolic, Gastrointestinal, Renal/Urologic, Pulmonary, Nervous, Skin/Exocrine, Musculoskeletal, Cardiovascular Genetics: None; some evidence for intrauterine transmission Incidence/Prevalence in USA: • About 100/year (105 cases in 1992; 0.34/100,000), but probably underreported • Common in developing countries; consider in immigrants • Highest rates in Hispanic population, along …

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Specific Anti-Infective Agents

Antibiotics Before prescribing a specific antibiotic, clinicians should be able to answer these questions: •  How does the antibiotic kill or inhibit bacterial growth? •  What are the antibiotic’s toxicities and how should they be monitored? •  How is the drug metabolized, and what are the dosing recommendations? Does the dosing schedule need to be modified in patients with renal dysfunction? •  What are the indications for using each specific antibiotic? •  How broad is the antibiotic’s antimicrobial spectrum? •  How much does the antibiotic cost? Clinicians should be familiar with the general classes of antibiotics, their mechanisms of action, and their major toxicities. The differences between the specific antibiotics in …

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Urinary Tract Infections and Prostatitis

Definition Infections of the urinary tract represent a wide variety of clinical syndromes including urethritis, cystitis, prostatitis, and pyelonephritis. A urinary tract infection is defined as the presence of microorganisms in the urine that cannot be accounted for by contamination. The organisms have the potential to invade the tissues of the urinary tract and adjacent structures. Lower tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Upper tract infections involve the kidney and are referred to as pyelonephritis. Uncomplicated urinary tract infections are not associated with structural or neurologic abnormalities that may interfere with the normal flow of urine or the voiding mechanism. Complicated urinary tract infections are …

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Antimicrobial therapy: general principles

A wide variety of antimicrobial agents is available to treat established infections caused by bacteria, fungi, viruses, or parasites. This section will cover the general principles of antimicrobial therapy and will also include illustrative clinical problems to emphasize proper decision-making in using antimicrobials. Determinants of Antimicrobial Efficacy Measurement of antimicrobial activity in vitro Susceptibility testing is indicated for any bacterial pathogen warranting chemotherapy. Drugs that irreversibly destroy the ability of an organism to replicate, and perhaps in the process destroy the structural integrity of the organism, are microbicidal. Drugs that reversibly impair replicating ability, with this function being restored when drug concentrations fall below critical inhibitory levels, are microbiostatic. In quantitative …

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Toxicity of Antimicrobial Therapy

Mechanisms of toxicity The mechanisms associated with common adverse reactions to antimicrobials include dose-related toxicity that occurs in a certain fraction of patients when a critical plasma concentration or total dose is exceeded, and toxicity that is unpredictable and mediated through allergic or idiosyncratic mechanisms. For example, certain classes of drugs such as the aminoglycosides are associated with dose-related toxicity. In contrast, the major toxicity of the penicillins and cephalosporins is due to allergic reactions. These differences are explained in part by the relative ability of specific drugs to inhibit enzymatic pathways in the host versus their stimulation of specific immune response. Not included in these lists is mention of the …

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Aminoglycosides – antibiotic agents

Aminoglycosides are very potent bactericidal antibiotic agents that are active against susceptible aerobic microorganisms. They kill by inhibiting protein synthesis and to some extent by lysing the cell envelope. All the aminoglycosides (streptomycin, kanamycin, neomycin, gentamicin, amikacin, tobramycin, sisomicin, and netilmicin) share common structural features. Streptomycin is used once a day in combination with other antibiotics to treat mycobacterial infections. Neomycin is used topically to treat superficial infections (a use to be discouraged) and is also given orally preoperatively for chemoprophylaxis before large-bowel surgery. The other agents are used parenterally to treat systemic bacterial septicemia (e.g., bacterial endocarditis, or urinary tract infections) or topically to treat local infection (e.g., bacterial conjunctivitis). …

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Aminoglycosides: Amikacin, Gentamicin, Kanamycin, or Tobramycin

Amikacin Sulfate, Gentamicin Sulfate, Kanamycin Sulfate, Neomycin Sulfate, Paromomycin Sulfate, Streptomycin Sulfate, Tobramycin Sulfate • Aminoglycosides are antibiotics that generally are active against many aerobic gram-negative bacteria and some aerobic gram-positive bacteria and principally are used for serious infections. Uses • Parenteral Amikacin, gentamicin, kanamycin, or tobramycin is used IM or IV in the short-term treatment of serious infections such as septicemia (including neonatal sepsis), bone and joint infections, skin and soft tissue infections (including those resulting from burns), respiratory tract infections, and postoperative and intra-abdominal infections (including peritonitis) caused by susceptible strains of gram-negative bacteria. The drugs also are effective in serious, complicated, recurrent urinary tract infections caused by susceptible …

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Extended-Spectrum Penicillins General Statement

Carbenicillin Indanyl Sodium, Piperacillin Sodium and Tazobactam Sodium, Ticarcillin Disodium, Ticarcillin Disodium and Clavulanate Potassium, Preface to the General Statements on Penicillins • Extended-spectrum penicillins are a group of semisynthetic penicillin antibiotics that, because of their chemical structures, have wider spectra of activity than natural penicillins, penicillinase-resistant penicillins, and aminopenicillins. Uses Oral carbenicillin indanyl sodium is used only for the treatment of acute or chronic infections of the upper and lower urinary tract, asymptomatic bacteriuria, or prostatitis caused by susceptible organisms. Ticarcillin and ticarcillin disodium and clavulanate potassium are used parenterally for the treatment of serious intra-abdominal infections, urinary tract infections, gynecologic infections, respiratory tract infections, skin and skin structure infections, …

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