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Abstract
The accuracy and precision of estimates of glomerular filtration rate (GFR) from serum creatinine, age, sex and body weight using the methods proposed by Cockroft and Gault and by Siersbaeck-Nielsen et al, were determined in 234 subjects on 574 occasions. The two methods gave almost identical estimates of GFR. As reference for determination of GFR plasma clearance of 51Cr-EDTA as described by Bröchner-Mortensen was used. The estimates of GFR gave a systematic deviation of about 10 ml/min and a precision of about +/- 15 ml/min (1 SD) in the GFR range between 30 and 90 ml/min.
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2
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Abstract
This review on infective endocarditis (IE) is based on clinical studies carried out in Göteborg since 1984, data obtained from a Swedish national registry of IE since 1995 and existing literature. IE is still a great challenge in medicine, although improved bacteriological and echocardiographical techniques have facilitated diagnosis. In Sweden the incidence of IE is about 6 per 100,000 inhabitants a year. During recent decades IE has changed character. Patients are older, fever is often the only major symptom and a new murmur is less frequent. Streptococci, including viridans species and staphylococci, are still the most common bacteria found. Antibiotic treatment for 4-6 weeks may reduce mortality of IE to 30-50%. For further reduction, heart surgery is necessary in 20-25% of patients in order to remove infected tissues and restore valve function. Rapid diagnosis, careful antibiotic treatment and optimal surgery may reduce mortality associated with treatment to 10%. Antibiotic treatment is still mainly empiric. Penicillin and aminoglycoside for 2 weeks only seem to be effective in uncomplicated IE caused by alpha-streptococci. Otherwise, 4 weeks of treatment is needed, but aminoglycoside treatment may be reduced to 1 week in general and 2 weeks for enterococcal infections.
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Affiliation(s)
- K Alestig
- Department of Infectious Diseases, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
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3
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Borres MP, Alestig K, Krantz I, Larsson P, Norvenius G, Stenqvist K. Carriage of penicillin-susceptible and non-susceptible pneumococci in healthy young children in Göteborg, Sweden. J Infect 2000; 40:141-4. [PMID: 10841089 DOI: 10.1016/s0163-4453(00)80006-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study carriage of Streptococcus pneumoniae among healthy young children, determine the proportion of strains with decreased susceptibility to penicillin, and study possible risk factors for the carriage of penicillin-resistant strains. METHODS Between February 1996 and February 1997, 620 healthy, 18-month-old children in Goteborg, Sweden were screened for carriage of S. pneumoniae with decreased susceptibility to penicillin. Nasopharyngeal samples were obtained from children visiting child health centres for routine health control. RESULTS Streptococus pneumoniae was found in 322 samples and 18 strains (5.6%, CI95 3.4; 8.8) of all pneumococci showed decreased susceptibility to penicillin G with minimum inhibitory concentrations (MICs) ranging from 0.125 to 1.0 mg/l. The proportion of strains with decreased susceptibility was similar to that found in a laboratory-based material (6%), from the same geographical area and time period. A majority of the children with strains with decreased susceptibility to penicillin (n = 11) were not attending day-care centres. CONCLUSIONS The prevalence of S. pneumoniae with reduced susceptibility to penicillin is still low in unselected healthy Swedish children.
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Affiliation(s)
- M P Borres
- Department of Paediatrics, Göteborg University, Sweden
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4
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Olaison L, Belin L, Hogevik H, Alestig K. Incidence of beta-lactam-induced delayed hypersensitivity and neutropenia during treatment of infective endocarditis. Arch Intern Med 1999; 159:607-15. [PMID: 10090118 DOI: 10.1001/archinte.159.6.607] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Long-term parenteral beta-lactam treatment is often complicated by adverse reactions that necessitate drug withdrawal. OBJECTIVE To evaluate the incidence and mechanism of beta-lactam adverse reactions during an 8-year period in all episodes of suspected infective endocarditis in patients treated at a university-affiliated institution. METHODS Patients with 215 consecutive episodes of beta-lactam treatment for 10 days or more were prospectively enrolled during 2 periods, January 1984 through December 1988 and January 1993 through December 1995, and compared with 51 episodes of vancomycin hydrochloride treatment for 10 days or more. Incidents of adverse reactions, such as fever, rash, or neutropenia, were registered. Neutrophil counts, eosinophil counts, and penicillin antibodies were studied. Patients with delayed adverse reactions to penicillin G sodium were rechallenged with penicillin v potassium. RESULTS Incidence of delayed adverse reactions during treatment was 33% with beta-lactams compared with 4% with vancomycin. Rates of adverse event for beta-lactams increased continuously from treatment day 15 to day 30. A 6-fold difference in capacity to induce adverse events was found with different beta-lactams. Penicillin G induced neutropenia in 14% and any adverse event in 51% of treated episodes. Mean daily doses significantly influenced the frequency of adverse events. Occurrence of hemagglutinating penicillin antibodies was significantly related to patients whose penicillin-treated episodes were complicated with adverse events. Patients with delayed adverse reactions to penicillin G were safely rechallenged with penicillin. CONCLUSIONS Incidence of delayed adverse reactions to beta-lactams increases sharply when parenteral treatment is extended beyond 2 weeks. Penicillin G is the most frequent inducer of adverse reactions among beta-lactams studied. An immunological reaction mediated by antibodies to the penicilloyl determinant may be involved in the pathogenesis, possibly enhanced by a dose-related toxic trigger mechanism. Beta-Lactam-induced neutropenia followed a uniform pattern, occurring after, on average, 21 days of treatment, and might be due to both immunologic and toxic effects of treatment. Patients with a late adverse reaction to penicillin can safely be re-treated with penicillin, although they should remain under close surveillance if treatment extends beyond 2 weeks.
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Affiliation(s)
- L Olaison
- Department of Infectious Diseases, Institute of Internal Medicine, Göteborg University, Sahlgrenska University Hospital, Sweden.
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5
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Olaison L, Hogevik H, Alestig K. Fever, C-reactive protein, and other acute-phase reactants during treatment of infective endocarditis. Arch Intern Med 1997; 157:885-92. [PMID: 9129548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fever and sustained elevations of levels of C-reactive protein, erythrocyte sedimentation rate, and other inflammatory markers are common problems during treatment of infective endocarditis. We studied the value of these measurements during an 8-year period in all episodes of infective endocarditis treated in 1 university-affiliated institution. METHODS A total of 193 consecutive episodes that fulfilled the criteria for infective endocarditis were prospectively enrolled during 2 periods, 1984 through 1988 and 1993 through 1995. Fever and results of serial measurements of C-reactive protein, erythrocyte sedimentation rate, white blood cell counts, and platelet counts were related to the clinical course of infective endocarditis. RESULTS Fever persisted or recurred in 108 episodes (57%) despite appropriate antibiotic treatment. The causes of persistent fever and recurrent fever were different. Persistent fever that lasted 7 days or longer was caused by a complicating cardiac infection in 56% of these episodes. Recurrent fever, noted in 31% of all episodes and the major cause of fever during the third and fourth treatment weeks, was caused most often by hypersensitivity reactions to beta-lactams. Elevations in C-reactive protein levels were significantly prolonged in the episodes with complicated courses compared with the episodes with uncomplicated courses, while mean erythrocyte sedimentation rate remained unchanged during treatment, not differentiating between complicated and uncomplicated episodes. CONCLUSIONS Fever during treatment must be analyzed in terms of persistence and recurrence to provide a basis for clinical decisions. Serial measurements of C-reactive protein are useful to monitor the response to antimicrobial therapy and to detect complications, while serial determinations of erythrocyte sedimentation rate are of no value.
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Affiliation(s)
- L Olaison
- Department of Infectious Diseases, Göteborg University, Sweden
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6
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Hogevik H, Olaison L, Andersson R, Alestig K. C-reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis. Infection 1997; 25:82-5. [PMID: 9108181 DOI: 10.1007/bf02113580] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this study was to evaluate the sensitivity of C-reactive protein (CRP) elevation compared to erythrocyte sedimentation rate (ESR), leucocyte count and thrombocyte count in the diagnosis of infective endocarditis (IE). It was designed as a prospective study of suspected episodes of IE in adults in tertiary care at a university-affiliated department of infectious diseases. In 89 episodes of IE, CRP was available from the start of treatment. Median age was 66 years, 45 were men and 44 women. Median CRP concentration was found to be 90 (range 0-357) mg/l with only 4% normal values. Episodes involving native valves had higher CRP than episodes occurring with prosthetic valves. Staphylococcal origin, short duration of symptoms, short duration of fever and highest recorded temperature all correlated to higher CRP levels. The CRP response was also prominent among patients > 70 years old. Among non-responders, a few cases with simultaneous cirrhosis were noted. ESR was less sensitive than CRP, with a normal level in 28% of the episodes. It was concluded that CRP determination is superior to erythrocyte sedimentation rate, leucocyte count and thrombocyte count in the diagnosis of infective endocarditis.
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Affiliation(s)
- H Hogevik
- Dept. of Infectious Diseases, Göteborg University, Ostra University Hospital, Sweden
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7
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Abstract
Background
A well established drug for the treatment of asthma and allergy, sodium cromoglycale, was found in open trials to be useful as a symptomalic treatment for upper respiratory tract infections. Objective
To compare the efficacy of inhaled and intranasal sodium cromoglyeate and matching placebos on the symptoms of upper respiratory tract infections. Methods
Adult subjects with symptoms of runny nose, throat pain, or cough for less than 24 h were recruited. They were treated for 7 days using a randomized, double‐blind, placebo‐controlled, group comparative design. The medication given was: sodium cromoglyeate dry powder 20mg per inhalation in spincaps; sodium cromoglycate aqueous nasal spray delivering 5.2mg per dose; or matching placebo as dry powder and nasal spray. One spincap and one spray per nostril were taken every 2h during waking hours on days 1 and 2 and then four times daily on days 3–7. Severity of nine symptoms (general malaise, body aches and pains, chills and shivering, snzeening, nasal running, nasal blocking, sore throat, cough and voice disturbance) was recorded twice daily by subjects on diary cards, using a scale of 0 (absent) to 3 (severe). Results
The sludy was conducted between February and April 1993. One hundred and eighteen patients aged 21–63 years (mean 41 years) were included. Symptoms resolved faster (P < 0.001) and the severity in the last three days of treatment was significantly less in patients treated with sodium cromoglycate than with placebo (P < 0.05‐day 5; P < 0.01‐day 6; P < 0.001‐day 7). Side‐effects were local and mild and did not differ between the treatment groups. Conclusion
Sodium cromoglyeate administered both by inhalation and intranasally is an effective treatment for the symptoms of upper respiratory tract infection. Its combined safety and efficacy would make it an acceptable form of treatment for these conditions.
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Affiliation(s)
- N Aberg
- Department of Paediatrics, University of Göteborg, East Hospital, Sweden
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8
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Sandberg T, Alestig K, Eilard T, Ek E, Hebelka M, Johansson E, Olinder-Nielsen AM. Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women. Scand J Infect Dis 1997; 29:175-9. [PMID: 9181655 DOI: 10.3109/00365549709035880] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.v. twice daily for 2 days followed by a 10-day course of oral cefadroxil 1 g twice daily, in the treatment of community-acquired acute pyelonephritis in women. Of 73 patients enrolled in the study, 51 could be evaluated according to the protocol. There were no significant differences in bacteriological cure rates between the combined treatment with tobramycin/cefotaxime and cefotaxime alone, either at short-term follow-up (63.0% vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9% vs 52.2%; 95% CI, -18.0% to 36.6%). A modified intention-to-treat analysis showed no difference in clinical efficacy between the two regimens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%). Tobramycin seemed to enhance the resolution of inflammation by a more rapid decline in C-reactive protein levels. The high recurrence rates after treatment with beta-lactam antibiotics in this and previous studies of acute pyelonephritis may be explained by adverse ecological effects rather than failure to eradicate the infection.
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Affiliation(s)
- T Sandberg
- Department of Infectious Diseases at Ostra University Hospital, Göteborg, Sweden
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9
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Alestig K, Borres M, Ek E, Fredlund H, Gustavsson O, Larsson P, Norvenius G, Roos K, Sandberg T, Stenqvist K, Oberg S. [Penicillin resistant pneumococci. Do not close the day care centers for healthy children]. Lakartidningen 1996; 93:2356-7; discussion 2357-8. [PMID: 8684044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- K Alestig
- Infektionskliniken, Ostra sjukhuset, Göteborg
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10
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Abstract
Optimal timing of surgical intervention in infective endocarditis is important in reducing mortality. We prospectively studied 126 consecutive episodes of infective endocarditis treated in one institution over 5 years, with special emphasis on long-term results and on the effects on outcome of surgical interventions. Twenty-six patients (21%) underwent acute surgery on median treatment day 14. Mortality during treatment was 8% for patients undergoing acute surgery vs. 11% for those not undergoing surgery, and the adjusted 5-year survival rate of acute surgically treated patients was 91%, compared with 69% for the medically treated patients. Using univariate analysis, excess mortality during 5 years follow-up was associated with new cardiac decompensation at entry (p < 0.01), age (p < 0.01), no acute surgery (p < 0.05) and mitral valve involvement (p < 0.05). Multivariate analysis showed new cardiac decompensation at entry to be an independent predictor of cardiac death at 5 years follow-up (relative risk 2.39; CI 1.05-5.45), while no surgery during active disease implied a relative risk of 3.45, though not statistically significant. Patients undergoing surgery very early (< or = 10 days of treatment) did not have a poorer outcome. Acute valve replacement, as compared with medical therapy only, might be important to increase both short-term and long-term survival in infective endocarditis.
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Affiliation(s)
- L Olaison
- Department of Infectious Diseases, Goteborg University, Sweden
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11
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Berg S, Trollfors B, Claesson BA, Alestig K, Gothefors L, Hugosson S, Lindquist L, Olcén P, Romanus V, Strangert K. Incidence and prognosis of meningitis due to Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis in Sweden. Scand J Infect Dis 1996; 28:247-52. [PMID: 8863355 DOI: 10.3109/00365549609027166] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The incidence, concomitant conditions and case fatality rate of Haemophilus influenzae (Hi) and pneumococcal meningitis and of invasive meningococcal infections were studied retrospectively in Sweden (population 8.4 million) for the years 1987-89, the period before vaccination against Hi type b started. A total of 1,019 cases with culture-verified infection were found. The incidence rates per 100,000 per year were 1.8 for Hi meningitis, 1.2 for pneumococcal meningitis and 1.0 for invasive meningococcal infections. The age-specific incidence was highest in the 3-23 months age group for the 3 bacterial species. Pneumococcal meningitis was common in individuals > or = 60 years and meningococcal infections in the age-group 10-24 years. A serious concomitant condition was known in 57% of all patients with pneumococcal meningitis while this was uncommon for the other organisms. The case fatality rate was 2% for Hi meningitis, 24% for pneumococcal meningitis and 10% for meningococcal infections. All 81 pneumococcal isolates which had been serotyped belonged to serotypes in the 23-valent pneumococcal vaccine. Of the meningococcal isolates, 65% belonged to serogroup B. In conclusion, the high incidence of Hib meningitis justifies general Hib vaccination. Development of a vaccine against N. meningitidis group B should have high priority. Furthermore, improved pneumococcal vaccines are needed for patients with predisposing conditions. The currently available pneumococcal polysaccharide vaccine seems to be underused.
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Affiliation(s)
- S Berg
- Department of Paediatrics, Mölndal Hospital, Sweden
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12
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Abstract
Candida endocarditis is an unusual but severe complication of systemic infection caused by Candida albicans and occasionally by other fungal species. We describe seven cases that occurred during a period of 20 years in western Sweden. In four cases infections were located on prosthetic valves and in three cases native valves were involved. Three patients died of the disease in the acute phase. A definite diagnosis was established in one of four survivors. This patient had an aortic valve endocarditis and a saddle embolisation and was treated with immediate surgery, followed by intensive treatment with liposomal amphotericin B+ flucytosine. Fungal endocarditis is still a serious disease with a high mortality and whenever the diagnosis is suspected, antifungal therapy must be started and transesophageal sonography should be performed to visualize vegetations. Immediate surgery should be considered.
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Affiliation(s)
- H Hogevik
- Dept. of Infectious Diseases, Göteborg University, Sweden
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13
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Milsom I, Landgren BM, Alestig K. [Connection between levonorgestrel-IUD and GAS (Group A Streptococcus) sepsis? Reliable risk assessment is not yet possible]. Lakartidningen 1995; 92:4781-2. [PMID: 8538290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- I Milsom
- Kvinnokliniken, Ostra sjukhuset, Göteborg
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14
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Abstract
A prospective study of the epidemiology of infective endocarditis (IE) in a well-defined urban population of 428,000 inhabitants during a 5-year period was carried out. All patients were treated in the same institution, and history, diagnostic procedures, and treatment were standardized. Of 233 consecutive suspected episodes of IE, 127 fulfilled the modified von Reyn criteria. After patients not living in the defined area were excluded, 99 episodes in 90 patients were analyzed in the epidemiologic part of the study. Of these, 33 episodes were definite endocarditis, verified by surgery or autopsy; 35 probable; and 31 possible endocarditis episodes. Another 34 episodes were found retrospectively and are included in the incidence calculation. The crude incidence was calculated to be 6.2/100,000 inhabitants per year, which is high compared to earlier studies. Adjusted to the population of Sweden, the incidence was 5.9/100,000 inhabitants per year. The annual incidence was higher for women, 6.6/100,000, than for men, 5.8/100,000. In the oldest age-group (80-89 years) the annual incidence was 22/100,000 in the prospective study and 30/100,000 if retrospective cases were included. Contrary to almost all other studies, we did not find a male predominance among our cases. Only 7% of patients were intravenous drug abusers, and 15% had a prosthetic valve. The most common bacteria were methicillin-susceptible Staphylococcus aureus (31%) and alpha-streptococci (28%); 12% of episodes were culture negative. The mortality from IE in the population was 1.4/100,000 inhabitants per year. A higher-than-expected incidence of IE was found, especially among older patients and women.
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Affiliation(s)
- H Hogevik
- Department of Infectious Diseases, Göteborg University, Sweden
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15
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Nylén O, Alestig K, Fasth A, Gustavii N, Olofsson J, Renvall U, Tjellström A, Wåhlén P. Infections of the ear with nontuberculous mycobacteria in three children. Pediatr Infect Dis J 1994; 13:653-6. [PMID: 7970956 DOI: 10.1097/00006454-199407000-00013] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- O Nylén
- Department of ENT, Ostra Hospital, University of Göteborg, Sweden
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16
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Alestig K. [Let the threadworm live!]. Lakartidningen 1993; 90:4196. [PMID: 7632187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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17
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Olaison L, Hogevik H, Larsson S, Alestig K. [Bacterial endocarditis--surgical treatment prolongs survival]. Lakartidningen 1992; 89:1289-91. [PMID: 1578997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- L Olaison
- Infektionskliniken, Ostra sjukhuset, Göteborg
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18
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Berg S, Trollfors B, Alestig K, Jodal U. Incidence, serogroups and case-fatality rate of invasive meningococcal infections in a Swedish region 1975-1989. Scand J Infect Dis 1992; 24:333-8. [PMID: 1509237 DOI: 10.3109/00365549209061339] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a retrospective study of invasive meningococcal infections in Greater Gothenburg, Sweden, 213 cases of culture-verified meningitis or septicaemia were identified during the 15-year period 1975-1989. The annual incidence was 2.0/100,000. Cases were seen in all age-groups with the highest rates in the 0-4 and 15-19 year-old groups, 9.5 and 6.2/100,000 respectively. 20% of the patients were less than 2 years. 91% of the patients had no known risk factors. In only 10 cases (5%) was contact with another case of meningococcal infection known. The main clinical manifestations were meningitis (57%), septicaemia with no sign of focal infection (25%) and septic shock (17%). The case-fatality rate for all the patients was 6.6% and did not change during the 15-year period. One-third of the patients who presented with septic shock died. The serogroup was known for strains from 192 patients. 51% of the strains belonged to serogroup B, 10% to group A and 23% to group C. In conclusion, the incidence of meningococcal infection was low but the relatively high case-fatality rate warrants a search for effective prophylaxis. About 30% of the cases were potentially preventable by the currently available tetravalent (A, C, Y and W135) polysaccharide vaccine, which is immunogenic in children greater than 2 years. Widespread use of antibiotic prophylaxis to close contacts of known cases would not lower the incidence markedly.
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Affiliation(s)
- S Berg
- Department of Paediatrics, Mölndal Hospital, Sweden
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19
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Hogevik H, Alestig K. [Septic thrombosis in the cavernous sinus causes permanent blindness]. Lakartidningen 1991; 88:1789. [PMID: 2041429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- H Hogevik
- Infektionskliniken, Ostra sjukhuset, Göteborg
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20
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Abstract
In 27 patients with a first episode of herpes simplex virus type 2 (HSV-2)-induced meningitis, confirmed by virus isolation from the cerebrospinal fluid (CSF) or seroconversion to HSV-2, initial neurologic complications were found in 10 (37%) but subsided before 6 months in all patients. Long-term complications were recurrent meningitis in 5 (19%) and periodic headache related to genital HSV recrudescences in 4 (15%). Seven additional patients had possible HSV-2-induced recurrent meningitis. In contrast to the first episode of meningitis, virus isolation, HSV antigen detection, and IgG analyses in consecutive serum samples were of no diagnostic value in episodes of HSV-2-induced recurrent meningitis. Instead, immunoblotting was used to assay intrathecally produced IgG antibodies to the HSV-2 type-specific protein gG-2 in recurrent meningitis, when CSF was collected at a minimum of 3 days after onset.
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Affiliation(s)
- T Bergström
- Department of Clinical Virology, University of Göteborg, Sweden
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21
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Abstract
A prospective study on the effect of beta-lactam antibiotics on granulopoiesis was carried out in 29 consecutive patients with bacterial endocarditis. Fourteen patients received a high dose of benzylpenicillin, up to 18 g/day, but in only three of them could the treatment be fulfilled as planned, for a mean time of 25 days. In 11 benzylpenicillin treated patients treatment had to be discontinued because of fever, rash or neutropenia. Neutropenia appeared in seven patients after 14-24 (mean 22) days. No superinfection occurred during the neutropenic phase which lasted 2-12 days. Patients with neutropenia differed significantly from others in having a lowered pretreatment neutrophil count (3.2 vs 10.4). In 15 patients treated with other beta-lactams, three cases of fever and rash and one case of neutropenia were seen in patients treated with cloxacillin 12 g daily. It was concluded that a daily dose of 18 g of benzylpenicillin is too high for longer treatment periods and that patients with initial low counts of neutrophils have an increased risk of developing neutropenia.
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Affiliation(s)
- L Olaison
- Department of Infectious Diseases, University of Göteborg, Ostra Hospital, Sweden
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Bergström T, Alestig K, Svennerholm B, Horal P, Sköldenberg B, Vahlne A. Neurovirulence of herpes simplex virus types 1 and 2 isolates in diseases of the central nervous system. Eur J Clin Microbiol Infect Dis 1990; 9:751-7. [PMID: 2175706 PMCID: PMC7088202 DOI: 10.1007/bf02184688] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Herpes simplex virus (HSV) isolates derived from the central nervous system of ten patients with HSV-1-induced encephalitis, one patient with multiple sclerosis, and 14 patients with HSV-2-induced meningitis were investigated for neurovirulence by assaying the LD50 after nose and intracerebral (i.c.) inoculation of mice. HSV-1 encephalitis strains were significantly more virulent after nose inoculation (i.e. neuroinvasive) when compared with HSV-1 isolates from patients with oral lesions only, whereas HSV-2 meningitis strains were significantly more virulent after i.c. inoculation when compared with HSV-2 isolates from patients with genital lesions only. No correlation between high neurovirulence (defined as low LD50 for both routes of infection) and replication in cell cultures of neuronal and non-neuronal cell lines was found, but the weakly neurovirulent HSV-1 strain isolated from a patient with multiple sclerosis gave low replication yields. After nose inoculation, a highly neuroinvasive HSV-1 laboratory reference strain replicated to high titers in nose tissue, the trigeminal ganglia and brainstem, while a strain with low neuroinvasiveness but high i.c. virulence replicated less well in the brainstem. Neuroinvasiveness of the virus strain might be one factor of relevance in the pathogenesis of HSV-1 encephalitis in man.
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Affiliation(s)
- T Bergström
- Department of Clinical Virology, University of Göteborg, Sweden
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23
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Abstract
We describe therapy with acyclovir in 1 patient with acute meningitis induced by herpes simplex virus type 2 (HSV-2) and in 1 patient with ascending myelitis in connection with meningitis after a primary genital HSV-2 infection. In addition, intermittent or continuous acyclovir prophylaxis against meningitis was employed in 3 patients with recurrent meningitis of probable HSV-2 etiology. Possible beneficial effects of the treatment were seen.
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Affiliation(s)
- T Bergström
- Department of Clinical Virology, University of Göteborg, Sweden
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Wiström J, Jertborn M, Hedström SA, Alestig K, Englund G, Jellheden B, Norrby SR. Short-term self-treatment of travellers' diarrhoea with norfloxacin: a placebo-controlled study. J Antimicrob Chemother 1989; 23:905-13. [PMID: 2668252 DOI: 10.1093/jac/23.6.905] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In a randomized, double blind, placebo-controlled, multicentre trial, 447 travellers to Africa, Asia or Latin America started three days treatment with norfloxacin 400 mg bd or placebo within 24 h after the onset of travellers' diarrhoea. One hundred and four subjects developed diarrhoea and of those 94 (46 in the norfloxacin group and 48 in the placebo group) could be analysed for efficacy. By the last treatment day, 34 patients in the norfloxacin and 18 in the placebo group were cured (P = 0.0001), four and three improved and five and 19, respectively, were failures. Recurrences were seen in three patients on norfloxacin and eight on placebo. The mean time to cure was 3.2 days in the norfloxacin group and 4.4 days in the placebo group (P less than 0.005). The number of loose stools was significantly lower in the norfloxacin group. Nine adverse events were reported; seven in the placebo and two in the norfloxacin group. Pre- and post-travel faecal samples were studied in 19 patients treated with norfloxacin, 21 treated with placebo and 21 untreated subjects without diarrhoea. In treated subjects, increased frequencies of Escherichia coli resistant to ampicillin, co-trimoxazole, doxycycline and chloramphenicol were found in both groups, though more frequently in the placebo one. No subject had norfloxacin resistant Esch. coli pre- and post-travel.
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Affiliation(s)
- J Wiström
- Department of Infectious Diseases, University of Umeå, Sweden
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25
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Sjögren E, Alestig K, Kaijser B. Campylobacter strains from Swedish patients with diarrhoea. Distribution of serotypes over a five year period. APMIS 1989; 97:221-6. [PMID: 2713133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Serotyping, HS antigen and HL antigen, was performed on 105 Campylobacter jejuni/coli isolates from the same number of consequtive patients seeking medical attention for diarrhoea. The results were compared to a similar study performed five years earlier. It was found that there were only minor differences in frequency of the serotypes commonly isolated during the two different periods.
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Affiliation(s)
- E Sjögren
- Department of Clinical Bacteriology, Ostra Hospital, University of Göteborg, Sweden
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Norrby SR, Dotevall L, Eriksson M, Settergren B, Larsson P, Lundholm R, Burman LA, Alestig K. Efficacy and safety of cefpirome (HR810). J Antimicrob Chemother 1988; 22:541-7. [PMID: 3204079 DOI: 10.1093/jac/22.4.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sixty adult patients with suspected systemic bacterial infections were treated with cefpirome 1 g or 2 g twice daily for 5-22 days. Forty-seven patients were evaluable for clinical efficacy. Diagnoses in evaluable patients were urinary tract infections (20), pneumonia (10), soft tissue infections (17), and bone and joint infections (4); four patients had two infections each. Nine patients were bacteraemic and all were cured; the responsible bacteria were Escherichia coli (6), Streptococcus pneumoniae (1), Pseudomonas aeruginosa (1), and Haemophilus influenzae (1). One patient with a soft tissue infection failed to respond clinically to cefpirome. Bacteriologically, 41 of 48 isolated pathogens (85%) were eradicated. In wound cultures, three strains of Staphylococcus aureus and one each of Ps. aeruginosa and Str. faecalis persisted. One Enterobacter sp. relapsed in urine. Of isolated strains, only Str. faecalis and methicillin resistant Staph, epidermidis were resistant to cefpirome. Staph, aureus strains were inhibited in vitro by 0.25 to 2 mg/l of cefpirome in agar dilution. Adverse effects, probably or possibly related to cefpirome, were skin reactions (3), fever (1), Clostridium difficile diarrhoea (2), and disturbed taste sensation (1). Tolerance was good. Cefpirome is suitable for large-scale comparative trials.
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Affiliation(s)
- S R Norrby
- Department of Infectious Diseases, University of Umeå, Sweden
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27
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Abstract
The glomerular filtration rate (GFR) was estimated from serum creatinine concentration in patients in whom the individual relation between GFR and serum creatinine had been previously determined. 51Cr-EDTA plasma clearance was used as reference method for GFR. The relation between 51Cr-EDTA clearance and estimated GFR was determined from 340 investigations in 197 adult patients with a variety of infectious and internal diseases. The imprecision of estimated GFR was 46% (1 CV) at 20 ml/min, 23% at 45 ml/min, 20% at 75 ml/min and 18% at 110 ml/min. This poor precision was probably due to the fact that many patients with acute infectious diseases, congestive heart failure, diabetes mellitus, etc., have an unstable renal function and therefore their creatinine distribution is not under steady state. This must always be considered when serum creatinine is used to estimate GFR.
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Affiliation(s)
- B Trollfors
- Department of Infectious Diseases, University of Gothenburg, Sweden
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AlObaidy A, Rödjer S, Alestig K, Carlberg H, Suurküla M. [Skin biopsy in fungal sepsis--a short-cut to diagnosis]. Lakartidningen 1987; 84:4147-8. [PMID: 3695753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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29
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Rödjer S, Alestig K, Bergmark J, Bergström T, Hultberg B, Jagenburg R, Olaisson L, Trollfors B, Westin J. Treatment of septicaemia in immunocompromised patients with ceftazidime or with tobramycin and cefuroxime, with special reference to renal effects. J Antimicrob Chemother 1987; 20:109-16. [PMID: 3305460 DOI: 10.1093/jac/20.1.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Fifty-two immunocompromised patients with suspected septicaemia were randomized on 61 occasions to treatment with ceftazidime or with tobramycin and cefuroxime. Most (90%) of the patients had haematological malignancies and were neutropenic (granulocytes less than 1 X 10(9)/1 in 40 of the 61 episodes). Blood cultures were positive in 22 (39%) febrile episodes and in four other instances positive cultures were obtained from other sources. Clinical cure or improvement was noted in 10 of 12 culture verified infections in the tobramycin and cefuroxime group and 11 of 14 episodes in the ceftazidime-group. The effect on the kidney of the two antibiotic regimens was studied by following the serum levels of creatinine, urea and beta 2-microglobulin and the urinary excretion of alanine aminopeptidase, N-acetyl-beta-D-glucosaminidase (beta-NAG) and beta 2-microglobulin. No clinically important renal side effects were observed. However, an increase in the urinary excretion of AAP was seen in both groups with significantly greater elevation in the tobramycin and cefuroxime group. Urinary beta-NAG increased only in the tobramycin and cefuroxime group.
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Abstract
In 75 patients with acute pneumonia of moderate severity a comparative study between transtracheal aspiration (TTA), sputum culture and epipharynx culture was carried out. Organisms considered as the probable etiological agent were found in 53% with TTA. The same organisms were found in only 27% in sputum samples and in 21% in epipharynx samples. No serious complications with TTA was noted.
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Alestig K, Sandberg T. Ethics in clinical studies. Scand J Infect Dis 1987; 19:275-6. [PMID: 3616493 DOI: 10.3109/00365548709032412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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32
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Björkman A, Brohult J, Pehrson PO, Willcox M, Rombo L, Hedman P, Kollie E, Alestig K, Hanson A, Bengtsson E. Monthly antimalarial chemotherapy to children in a holoendemic area of Liberia. Ann Trop Med Parasitol 1986; 80:155-67. [PMID: 3530156 DOI: 10.1080/00034983.1986.11812000] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two hundred and eighty-two children, two to nine years old, were included in a prospective three-year study in four villages with holoendemic malaria. In three villages the children received monthly doses of either chloroquine, pyrimethamine or chlorproguanil respectively for two years. In the fourth, vitamin tablets were used as placebo. Presumptive treatment with chloroquine (10 mg base kg-1) was given to all children with fever of suspected malarial origin. The two-year drug distribution was satisfactorily fulfilled to 168 children. Surveys, including physical and laboratory examinations were performed every six months, four weeks after medication. A fifth village was only visited at the start of the study and after two years. The mean crude parasite rate was initially 92%. Plasmodium falciparum was the main species. Splenomegaly was recorded in all children. In the chloroquine-treated children, the parasite rates varied between 30% and 50% during the study. By the end of the second year the spleen rate was reduced from 100% to 50%. Reported episodes of fever were reduced to half and mean haematocrit levels increased by 6% in comparison with children receiving the placebo. Total IgG concentrations were reduced from 36.7 g l-1 to 25.9 g l-1, whereas no significant decrease was observed in malarial seropositivity as measured by indirect immunofluorescence. Chlorproguanil had a weaker impact on parasitaemia with parasite rates between 50% and 90%. However, the spleen rate was reduced to 67% and there was a significant reduction of reported fever episodes. Mean haematocrits increased by 4%. Total IgG decreased from 31.8 g l-1 to 23.8 g l-1. In contrast, in the pyrimethamine group, the placebo group and the untreated group from the fifth village, the malariometric indices after two years were comparable to each other and to the initial values. During the third year only presumptive chloroquine treatment was given, and by the end of the study all malariometric indices were again comparable. From clinical observations there was no apparent impairment of protective immunity to malaria from the two years of regular distribution of the drugs. We conclude that a certain degree of malaria control could be achieved in Liberian children by the administration of monthly doses of chloroquine 10 mg base kg-1. The administration of chlorproguanil (1.5 mg kg-1) represents an alternative regimen.
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Abstract
In order to determine whether healthy adults can be of importance for the spread of pertussis the nasopharyngeal flora of 391 healthy individuals working in close contact with children was investigated during the height of a pertussis epidemic. Only 1 carrier of Bordetella pertussis was found, even though all individuals were exposed to the organism during the study period through their work.
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Hagberg L, Malmvall BE, Svennerholm L, Alestig K, Norkrans G. Guillain-Barré syndrome as an early manifestation of HIV central nervous system infection. Scand J Infect Dis 1986; 18:591-2. [PMID: 3468607 DOI: 10.3109/00365548609021668] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two cases of HIV infection associated with Guillain-Barré syndrome are described. The neurologic symptoms started 1 week and 20 weeks, respectively, after the primary HIV infection. Seroconversion for anti-HIV occurred during the disease. A rapid spread of virus to the central nervous system was shown.
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Bergström T, Alestig K, Thorén K, Trollfors B. Symptomatic treatment of acute infectious diarrhoea: loperamide versus placebo in a double-blind trial. J Infect 1986; 12:35-8. [PMID: 3514770 DOI: 10.1016/s0163-4453(86)94833-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One hundred and twelve patients with acute infectious diarrhoea were entered in a double-blind randomised study in order to compare loperamide with a placebo. Of 82 evaluable patients, 38 received loperamide and 44 placebo for a maximum of 5 days. There were no significant differences in the number of loose stools during the first day of treatment, in the total number of tablets taken or in the total duration of the period of diarrhoea between the two treatment groups. The loperamide-treated patients had significantly fewer loose stools during the observation period of 5 days than did the placebo treated patients, median five vs. seven, a difference of little clinical importance. Excretion of bacterial pathogens was followed weekly in 13 of the loperamide treated patients (median 35.5 days) and in 18 of the placebo treated patients (median 22.5 days). This difference in the duration of excretion was not significant.
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Abstract
11 patients with moderate infections were treated with bolus injections of tobramycin in a fixed dose of 4.5 mg/kg and day for 8 days. The patients were randomized to injections every 8 h (TID) for 4 days followed by injection every 12 h (BID) or vice versa. Serum concentrations were measured on day 2 of each regimen. The TID regimen gave peak levels less than 4 micrograms/ml in 5/11 patients, mean value 4.2 micrograms/ml. With the BID regimen 2 patients had peaks less than 4 micrograms/ml, mean value 5.9 micrograms/ml. The BID regimen seems preferable when treating patients with normal renal function. The bolus injections were well tolerated.
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Malmvall BE, Alestig K, Brorson JE, Elgefors B. Clinical evaluation of lysis-centrifugation technique and a biphasic bottle system for blood culture. Scand J Infect Dis 1985; 17:401-6. [PMID: 4089545 DOI: 10.3109/13813458509058781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The lysis centrifugation technique (Isolator, DuPont) for blood culture was compared with a system with biphasic medium in bottles. The Isolator was filled with 10 ml of blood once. One aerobic and one anaerobic bottle were injected 3 times with 2.5 ml of blood each. Organisms were detected in 90/748 blood cultures; 26 of which were contaminants. 34 pathogens were detected by both methods, 12 with the Isolator only and 18 with the 3 bottle pairs only. The first pair of bottles revealed 45/52 isolates, the second and third pairs gave an additional 6 and 1 isolate respectively. The contamination rate was 2.3% for the Isolator, which is lower than earlier reported, and 1.3% for the bottles. The most common pathogens were Escherichia coli, Pseudomonas aeruginosa and Streptococcus pneumoniae. The Isolator gave a faster diagnosis in 23 of the 34 cases. No decrease in the recovery rate was seen after 8 h, the longest recommended transport time for the Isolator tubes. One Isolator gave the same yield as the first pair of bottles and combining the methods increased the yield 25% compared to either method alone.
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39
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Sköldenberg B, Forsgren M, Alestig K, Bergström T, Burman L, Dahlqvist E, Forkman A, Frydén A, Lövgren K, Norlin K. Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet 1984; 2:707-11. [PMID: 6148470 DOI: 10.1016/s0140-6736(84)92623-0] [Citation(s) in RCA: 368] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
127 patients with suspected herpes simplex encephalitis (HSE) were entered in a prospective randomised study of acyclovir 10 mg/kg 8-hourly versus vidarabine 15 mg/kg daily for 10 days. The patients were consecutive and nearly all Swedish cases of HSE were included; they were treated in six university infectious diseases departments. The diagnosis of HSE was verified by brain biopsy and/or antibody responses in serum and cerebrospinal fluid. Of 53 confirmed cases of HSE (corresponding to 2 X 3 cases per million inhabitants per year in Sweden), 51 (27 acyclovir, 24 vidarabine) were evaluable for analysis of efficacy. The mortality was 19% in the acyclovir-treated group versus 50% in the vidarabine group (p = 0.04). At 6 months of observation 15 (56%) of 27 acyclovir-treated patients had returned to normal life compared with 3 (13%) of 24 vidarabine-treated patients (p = 0.002); and the numbers who died or had severe sequelae were 9 (33%) and 19 (76%), respectively (p = 0.005). No important or new adverse events were recognised.
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40
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Abstract
Glomerular filtration rate (GFR) as measured by 51Chrome-EDTA clearance, decreased with a mean of 10 ml/min during therapy with ceftazidime 2 g bid in 16 patients with initial GFR of 30 to 110 ml/min. A significant increase in the excretion of urinary alanine aminopeptidase was also found. In another three patients with initial GFR of 17-22 ml/min increases in serum creatinine during therapy were noted. These observations indicate that ceftazidime should be used with caution in patients with impaired renal function and not be combined with nephrotoxic drugs until the safety of such combinations has been studied.
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41
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Andréasson S, Larsson LE, Bergström T, Alestig K. Severe acute encephalitis--improved outcome after barbiturate treatment? Scand J Infect Dis 1984; 16:25-7. [PMID: 6695156 DOI: 10.3109/00365548409068405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Six cases of severe encephalitis due to measles, varicellae, mononucleosis, influenza, rubella and pertussis were treated with high doses of barbiturates in combination with steroids and artificial hyperventilation. Four of the patients also received antiviral therapy. They all survived without neurological sequelae. The use of barbiturates in high doses may be of importance for an improved outcome in patients with severe encephalitis.
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Trollfors B, Alestig K, Rödjer S, Sandberg T, Westin J. Renal function in patients treated with tobramycin-cefuroxime or tobramycin-penicillin G. J Antimicrob Chemother 1983; 12:641-5. [PMID: 6363382 DOI: 10.1093/jac/12.6.641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In order to evaluate the potentiating effect of cefuroxime on tobramycin nephrotoxicity 21 immunocompromised patients with suspected septicaemia were randomized to treatment with either tobramycin + cefuroxime or tobramycin + penicillin G. 51Chromium-EDTA clearance, serum creatinine, serum beta 2-microglobulin, urinary, alanine aminopeptidase, urinary N-acetyl-beta-D-glucosaminidase and urinary beta 2-microglobulin were measured during a nine day course of the antibiotic combinations. Enzymuria and a small but significant decrease of 51Chromium-EDTA clearance of equal magnitude in both treatment groups occurred. However the results cannot be extrapolated to other doses and treatment times than used in the study.
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Abstract
The effect of cefoperazone on the intestinal flora was investigated in 29 patients receiving the drug for 7 to 14 days. Faecal specimens were cultured quantitatively for aerobic and anaerobic micro-organisms before, during and after therapy. The cefoperazone treatment was associated with major changes in the faecal flora. There was marked suppression of enterobacteria, staphylococci, streptococci, anaerobic cocci, bacteroides, fusobacteria, bifidobacteria, eubacteria and lactobacilli. The number of enterococci increased in most patients and the number of clostridia remained constant. Eight patients had cultures positive for Clostridium difficile during or after treatment. The marked changes in the intestinal flora can have important clinical consequences.
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Abstract
In an open trial, the efficacy of intravenously administered ceftazidime was evaluated in 106 adult patients with urinary or respiratory tract infections, soft tissue infections, osteitis and septicaemia. The most commonly isolated pathogens were Escherichia coli, Pseudomonas spp. and Staphylococcus aureus. Of 85 organisms isolated before treatment, 79% were cleared and 15% were cleared but later relapsed often because of the underlying conditions. Clinical cure was achieved in 70%, improvement occurred in 25% of the patients and 6% failed to respond. Marked increases in serum creatinine occurred in three patients with pre-existing renal impairment treated with ceftazidime in unmodified dosage. Exanthema, diarrhoea or local thrombophlebitis was noted in 13 patients.
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Norrby SR, Alestig K, Ferber F, Huber JL, Jones KH, Kahan FM, Meisinger MA, Rogers JD. Pharmacokinetics and tolerance of N-formimidoyl thienamycin (MK0787) in humans. Antimicrob Agents Chemother 1983; 23:293-9. [PMID: 6573156 PMCID: PMC186040 DOI: 10.1128/aac.23.2.293] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The pharmacokinetics of intravenously administered N-formimidoyl thienamycin (MK0787) were studied in 14 healthy male subjects in a single-dose study, in which the volunteers received N-formimidoyl thienamycin with and without probenecid, and in a multiple-dose study, in which the subjects were given 250 or 500 mg every 8 h for 10 doses. High dose-related plasma concentrations of N-formimidoyl thienamycin were achieved; co-administration with probenecid resulted in only minor increases in these concentrations. No accumulation in plasma was seen after multiple doses. The plasma half-life of N-formimidoyl thienamycin was slightly less than 1 h and did not increase significantly with the coadministration of probenecid. The urinary recovery of N-formimidoyl thienamycin varied between 6.0 and 38.4% of the dose with a marked intersubject variability. Variations in individual subjects were small, however, when the urinary recoveries after repeated doses were compared. These results were in agreement with previous animal studies showing a renal metabolism of N-formimidoyl thienamycin. Probenecid administration resulted in a marked decrease in N-formimidoyl thienamycin urinary recovery. In vitro experiments showed that the decay of N-formimidoyl thienamycin in spiked pretreatment urine samples was 2 to 5%/h with more rapid degradation at acidic than at basic pH.
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Norrby SR, Alestig K, Björnegård B, Burman LA, Ferber F, Huber JL, Jones KH, Kahan FM, Kahan JS, Kropp H, Meisinger MA, Sundelof JG. Urinary recovery of N-formimidoyl thienamycin (MK0787) as affected by coadministration of N-formimidoyl thienamycin dehydropeptidase inhibitors. Antimicrob Agents Chemother 1983; 23:300-7. [PMID: 6573157 PMCID: PMC186041 DOI: 10.1128/aac.23.2.300] [Citation(s) in RCA: 128] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
N-Formimidoyl thienamycin (MK0787) undergoes renal metabolism by a dipeptidase, dehydropeptidase I, located on the brush border of the proximal tubular cells. The effects of two inhibitors (MK-789 and MK-791) of dehydropeptidase I on the pharmacokinetics of N-formimidoyl thienamycin were studied in 41 healthy subjects receiving various combinations of N-formimidoyl thienamycin and MK-789 or MK-791. Both inhibitors affected the plasma kinetics of N-formimidoyl thienamycin only to a small extent. Plasma concentrations and the area under the plasma concentration curve increased about 20% with a proportional decrease in plasma clearance. Plasma half-life was not altered significantly. Coadministration of MK-789 or MK-791 resulted in uniform and marked increases in urinary recovery and renal clearance of N-formimidoyl thienamycin. Thus, at an N-formimidoyl thienamycin/MK-791 ratio of 1:0.25 or higher, the urinary recovery was about 72% in all subjects, whereas it varied between 7.7 and 43% when N-formimidoyl thienamycin was given alone. The ratio of the N-formimidoyl thienamycin and MK-791 doses affected response. At relatively higher doses of MK-791, significant increases of N-formimidoyl thienamycin urinary recovery, renal clearance, and urine concentrations occurred during the later part of the 10-h observation period after each administration. At a 1:1 ratio of the two drugs, the inhibition of renal metabolism of N-formimidoyl thienamycin was maintained for at least 8 h, whereas renal clearance declined as soon as 4 h after the administration of a 1:0.25 ratio. The results indicated that MK-789 and MK-791 alter the renal excretion of N-formimidoyl thienamycin from glomerular filtration plus tubular secretion to glomerular filtration only, possibly by competitively inhibiting the penetration of N-formimidoyl thienamycin into the proximal tubular cells.
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50
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Brandberg A, Alestig K, Elgefors B. [Drinking water with salt for cleaning and care of infected wounds]. Lakartidningen 1982; 79:738-40. [PMID: 7098677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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