[Double-blind clinical trial comparing 5 days of dirithromycin versus 7 days of diacetylmidecamycin in acute bronchitis and acute exacerbations of chronic bronchitis]

BACKGROUND

Dirythromycin has several pharmacokinetic characteristics (long half life and high tissue concentrations) which suggest the possibility of administering shorter treatments than those conventionally used. The aim of this study was to determine and compare the efficacy of a 5 day treatment with dirythromycin once a day, versus diacetylmidecamycin twice a day over 7 days in the treatment of patients with acute bronchitis and acute exacerbations of chronic bronchitis.

METHODS

A parallel, multicentric, randomized, double blind clinical study was carried out in 8 Spanish hospitals.

RESULTS

One hundred seventy-four patients were included in the study, with 87 (80 evaluable) being randomly assigned to receive dirythromycin (500 mg/day over 5 days) and 87 (83 evaluable) diacetylmidecamycin (600 mg, twice daily over 7 days). A favorable symptomatic response (cure or improvement) was observed in 72/80 of the first group (90%) and in 74/83 (89.2%) of the second group. No statistically significant differences were found in the efficacy and safety between the two treatment groups in either the evaluable patients or on intention to treat analysis.

CONCLUSIONS

The results of this study suggest that the administration of dirythromycin, once a day over 5 days, is as safe and effective as diacetylmidecamycin, twice a day over 7 days, in the treatment of acute bronchitis and acute exacerbations of chronic bronchitis.

Nosocomial outbreak of Burkholderia pickettii infection due to a manufactured intravenous product used in three hospitals

Forty-six cases of nosocomial infection caused by Burkholderia pickettii were reported between June and November 1993 in three metropolitan hospitals in Madrid. A case-control study of the outbreak was conducted to identify its cause. Seventy-four percent of the patients were males; the mean age +/- SD of the patients was 54 +/- 20 years. Sixty-five percent of the patients presented with some gastrointestinal disorder, and 80% had a peripheral catheter; 98% were treated with intravenous fluids, and 96% were treated with intravenous ranitidine. On the basis of results of a descriptive study and knowledge of the epidemiologic features of B. pickettii, a provisional causal hypothesis was formulated: intravenous ranitidine was the source of the outbreak. As a control measure, it was advised to stop treatment with this drug. On the basis of results of logistic regression and the microbiological isolation of B. pickettii in an ampule of the drug, we concluded that intravenous ranitidine was the cause of the outbreak.

[The stability of antibiotics administered in "and" with a parenteral nutrition mixture enriched with branched-chain amino acids. II. The cephalosporins]

Part I of these stability studies commented on the benefits, in terms of care and therapy, of the Y administration of antibiotics and parenteral nutrition. The aim of this study is to determine the stability of the cephalosporins ceftazidime, ceftriaxone, ceftizosime and cefotaxime in vitro, at therapeutic concentrations, infused together with a parenteral nutrition mixture with polyols, enriched in branched chained amino acids, and without lipids. A microbiological stability analysis was carried out on the antibiotics in the parenteral nutrition, and an HPLC aminogram was done to determine the concentration of amino acids in the infusion together with the antibiotic. As well, pH, osmolarity and colour change were measured in the antibiotics, in the parenteral nutrition used and in the joint infusion mixtures. It is concluded that parenteral nutrition can be jointly infused with cefotaxime and ceftazidime, at the concentrations studied, given the stability results obtained both with HPLC (antibiotics and amino acids) and microbiologically (antibiotics). At the same time, the microbiological analysis of ceftriaxone with the nutrition showed its stability in the study conditions. Its joint infusion with parenteral nutrition, studied by HPLC, confirmed the stability of the amino acids. The ceftizoxime analysed by HPLC remained stable during joint infusion with the parenteral nutrition.

[The stability of antibiotics administered in and with a parenteral nutrition mixture enriched with branched-chain amino acids. I. Amikacin and gentamycin]

The combined infusion of antibiotics and parenteral nutrition makes it possible to maintain plasmatic nutrient concentrations over time, in turn facilitating the administration of the antibiotics in the dilution and infusion time recommended according to their pharmacokinetic parameters. On the other hand, this type of administration has care benefits for the patient, reducing the risk of infections, and adding to comfort. The technique is also cost-effective, reducing the cost of drug administration, saving on administrative personnel and nursing staff time. The stability of amikacin and gentamicin are determined in vitro at therapeutic concentrations jointly infused with a mixture of parenteral nutrition with polyols and enriched in ramified chain amino acids. A microbiological stability analysis was carried out of the antibiotics in the parenteral nutrition, along with an HPLC aminogram, in order to determine the concentration of amino acids in the combined infusion with the antibiotic. pH measurements were also taken, along with osmolarity and colour change. Both of the antibiotics and the parenteral nutrition employed, and of the combined infusion mixtures. Amikacin and Gentamicin are stable at a concentration of 5 mg/ml and 1.6 mg/ml respectively in a parenteral nutrition mixture enriched in ramified chain amino acids.

[Infection by HIV and the hepatitis B, C, and D viruses in intravenous drug addicts. Seroprevalence at 1 year and its follow-up]

BACKGROUND

The aim of the present article was to study the serology of intravenous drug user patients against the hepatitis B, C, D, and HIV, during 1990 and the follow-up during the same year, and 1991.

METHODS

A study of 265 patients (mean age: 25 years, range: 16-45; 206 males and 59 females) was carried out. Forty-two percent came because of detoxication treatment, 30% requested diagnosis for hepatic disturbances and the only data provided in 28% were that they were intravenous drug users. None of the patients was an inmate from prisons.

RESULTS

Seroprevalences were 67.5% for the HBV, 75.6% for HCV, 17% for HDV and 50.2% for HIV. In the patients seronegative for HBV (65%) and HIV (58%) no new serologic controls were performed during the study period, while in those who underwent controls the rates of seroconversion were 43.3% and 32%, respectively. In 30% of all seroconversions to HBV coinfection with HDV was found and in 23% antibodies against HIV were observed.

CONCLUSIONS

Due to the high rates of infection obtained, the authors believe that serologic follow up of intravenous drug users is advisable.