Cardiac involvement in human immunodeficiency virus-infected patients

Heart involvement in patients with AIDS has been described in autopsy and clinical series, but the true incidence in HIV-infected patients is not clear. A prospective study was done on 101 unselected HIV-infected patients (71 with AIDS and 30 with pre-AIDS) and 24 healthy controls to assess the prevalence of cardiac abnormalities. Assessment included physical examination, electrocardiogram, two-dimensional echocardiogram, and Doppler studies. At least one abnormality was detected in 41 (40.6%) HIV-infected patients vs. 3 (12.5%) in controls (p = 0.003). Echocardiographic abnormalities were detected in 29 (28.7%) HIV-infected patients and 3 (12.5%) controls (p = 0.04). There were no significant differences in abnormalities on physical examination, electrocardiogram, or Doppler studies. Only six (5.9%) HIV-infected patients had abnormal cardiac findings on physical examination. We found no correlation between HIV staging, CD4 cell count, acute illness, or severity of illness and the presence of cardiac abnormalities. Cardiac abnormalities in HIV-infected patients are more frequent than in healthy controls, but most abnormalities are of no significant clinical consequence.

Infection of arterio-venous fistulas created for chronic haemodialysis

One of the complications of chronic haemodialysis is infection at the venous access site. A retrospective chart review (1985-1990) was done on patients requiring venoaccess for haemodialysis. 197 patients had 254 arterio-venous (A-V) fistulas created. 40 patients had 71 prosthetic implants and 157 patients had 183 autogenous fistulas created. 16 (22%) prosthetic grafts were infected versus 8 (4.3%) autogenous fistulas (p < 0.0001). Bacteraemia was present in 9/16 (56%) infected prosthetic grafts and 4/8 (50%) infected autogenous fistulas. Seven (43.8%) of the prosthetic grafts required removal; 6 (37.5%) were cured with drainage, irrigation and antibiotics, and 3 (18.8%) with antibiotics alone. One (12.5%) of the autogenous fistulas was removed, 4 (50%) required revision and 3 (37.5%) were treated with antibiotics alone. Whenever possible, A-V fistulas should be created in the arms with an autogenous graft as infections are less and easier to treat.

A randomized comparative study of the prophylactic use of trimethoprim-sulfamethoxazole versus netilmycin-metronidazole in transrectal prostatic biopsy

An open randomized study was done to compare the prophylactic value of single doses of netilmycin-metronidazole versus trimethoprim-sulfamethoxazole in the prevention of postoperative infections associated with transrectal prostatic biopsy. Of 117 patients enrolled in the study 101 were evaluated and of these patients 47 received netilmycin-metronidazole and 54 received trimethoprim-sulfamethoxazole. The bacteremia rate in the netilmycin-metronidazole group was 28% (13 of 47 patients) with a 95% confidence interval of 18 to 42% and in the trimethoprim-sulfamethoxazole group it was 37% (20 of 54) with a confidence interval of 26 to 50% (p = 0.43). None of the patients with bacteremia was symptomatic. Urinary tract infection rates were greater in the netilmycin-metronidazole group: 17% (8 of 47 patients) versus 2% (1 of 54) in the trimethoprim-sulfamethoxazole group, p = 0.01. Trimethoprim-sulfamethoxazole (cotrimoxazole) is a better choice as an antimicrobial prophylaxis for patients undergoing transrectal prostatic biopsy.

Bone penetration of enoxacin in patients with and without osteomyelitis

Enoxacin concentrations in bone were measured in 24 patients without infection and in 7 with osteomyelitis after one or two doses of 400 mg of enoxacin administered orally or intravenously. Enoxacin concentrations were measured in serum and bone (cortical and cancellous) by high-pressure liquid chromatography. The mean concentration in serum was 2.4 +/- 1.0 micrograms/ml (range, 1.3 to 5.2 micrograms/ml) and was highest after two intravenous doses (3.1 +/- 0.9 micrograms/ml). The mean concentration in cortical bone was 1.0 +/- 0.9 micrograms/g (range, 0.4 to 4.8 micrograms/g) and was highest in patients with osteomyelitis (1.3 +/- 1.6 micrograms/g), but this was not statistically significant. The concentration of enoxacin in cancellous bone was significantly higher than that in cortical bone, with a penetration of 82 versus 40%. Oral enoxacin in practical doses can provide significant levels in bone, and further studies are warranted to determine its therapeutic efficacy in osteomyelitis.

Penetration of enoxacin into bronchial secretions

Enoxacin is a potent quinolone derivative with marked activity against gram-negative bacteria and staphylococci. The oral preparation has a potential role in treatment of gram-negative-bacterial lower respiratory infections if found to give adequate bronchial (sputum) concentrations. A study was done to determine the concomitant serum and bronchial concentrations of oral enoxacin after dosing with 600 mg, single dose; 400 mg, single dose; and 400 mg every 12 h, four doses. Blood and bronchial secretions were collected from 20 patients predose and 2, 5, and 9 h postdose. Bronchial secretions were obtained from tracheostomies, endotracheal tubes, or bronchoscopy. Levels of enoxacin in serum and sputum were measured by high-pressure liquid chromatography. Mean peak bronchial secretion levels were similar for the 400-mg dose schedules (2.2 and 2.4 micrograms/ml) but were significantly higher with the 600-mg dose (4.0 micrograms/ml) (P less than 0.05). Significant concentrations in bronchial secretions were still achievable at 9 h postdose (1.3 to 2.3 micrograms of enoxacin per ml). The mean ratios of enoxacin concentrations in sputum to those in serum at various time intervals for all groups were as follows: at 2 h, 0.55 +/- 0.34; at 5 h, 1.04 +/- 0.72; at 9 h, 0.97 +/- 0.62. Considering that most gram-negative bacteria are inhibited by 1.0 microgram of enoxacin per ml in vitro, this study shows that oral enoxacin in practical doses achieves a concentration in bronchial secretions that is adequate to treat most gram-negative-bacterial lower respiratory infections.

Treatment of nongonococcal urethritis with ciprofloxacin

A randomized, double-blind study was performed in 225 men with nongonococcal urethritis or postgonococcal urethritis, in which the efficacy of ciprofloxacin (750 mg twice daily for seven days) was compared with that of doxycycline (100 mg twice daily for seven days). Of the 145 evaluable patients completing three weeks or more of follow-up or reaching an end point, 74 patients received doxycycline and 71 received ciprofloxacin. Chlamydia trachomatis and mixed infections with Ureaplasma urealyticum were more frequent in the cip, ofloxacin group, but the differences were not significant. The overall cure rates were similar for the two regimens (52.1 percent for ciprofloxacin and 60.8 percent for doxycycline; p greater than 0.3). However, in patients with chlamydial infections alone, ciprofloxacin was significantly less effective than doxycycline (45.5 percent versus 75 percent; p = 0.04). In patients with U. urealyticum infections alone, there was a more favorable trend in the ciprofloxacin group (69.2 percent versus 45 percent; p = 0.12). In patients whose culture results were negative, the responses were very similar (60.9 percent for ciprofloxacin and 64.3 percent for doxycycline). Both drugs were well tolerated; side effects, which were mostly gastrointestinal in nature, were mild.

Comparative clinical efficacy of single oral doses of cefuroxime axetil and amoxicillin in uncomplicated gonococcal infections

Cefuroxime axetil (1.5 g) was compared with amoxicillin (3 g), both given as a single oral dose combined with probenecid (1 g) for the treatment of uncomplicated gonorrhea. Of 60 evaluable patients receiving amoxicillin, 55 (91.7%) were cured, whereas 55 (96.5%) of the 57 patients receiving cefuroxime axetil were cured (P greater than 0.1). Both drugs were well tolerated.

Ciprofloxacin concentrations in bone and muscle after oral dosing

Ciprofloxacin, a quinoline derivative with marked gram-negative and staphylococcal activity, may be a valuable orally administered agent for use against soft-tissue and bone infections. The concentrations of this antibiotic in serum, bone, and muscle samples were determined in patients undergoing orthopedic surgery. A total of 18 patients undergoing hip or knee replacement surgery or osteotomy were randomized to receive single oral doses of ciprofloxacin (500 mg, 750 mg, or 1 g); 10 patients with osteomyelitis were given single doses of 500 or 750 mg. Mean levels in bone of more than 1 microgram/g were achieved with the 750-mg ciprofloxacin doses in patients with osteomyelitis (1.4 +/- 1 microgram/g) or with the 1-g doses in patients without infections (1.6 +/- 0.6 microgram/g). The levels in muscle were significantly higher with each increasing dose level. Orally administered ciprofloxacin (750 mg given every 12 h) should provide adequate concentrations in bones and soft tissues to treat most osteomyelitis and soft-tissue infections.