Nutritional impact of antipseudomonas intravenous antibiotic courses in cystic fibrosis

Editor,—In their study of cystic fibrosis patients who were nutritionally assessed at the start and end of a 14 day period of home intravenous antibiotic treatment for chest disease, Vicet al concluded that increased weight was a result of increased fat storage.1 While this may in part be true, their methodology dictates caution in drawing conclusions....

Antibiotic 26-deoxylaidlomycin isolated from Streptomyces sp. Ar386 from Brazilian soil

An actinomycete strain (Ar386) was isolated from the soil of the Araraquara regio, SP, Brazil. The strain, named Streptomyces jacareensis, formed irregular rayed, rugose, grayish-white mycelium with sinuous, branched hyphae carrying rare isolated spores; assimilated glucose, galactose, inositol, ribose, maltose, sucrose, melibiose and starch but not mannitol, rhamnose, arabinose, xylose, lactose and raffinose; and contained LL- diaminopimelic acid in its cell wall. An antibiotic active against Gram- positive bacteria, which was characterized as being 26-deoxylaidlomycin and which may have application against poultry coccidiosis, was isolated from cultures of the strain. This was the first isolation of this antibiotic from a microorganism of the genus Streptomyces and also the first isolation of this antibiotic in Brazil.

Re-evaluation of antibiotic and mercury resistance in Escherichia coli populations isolated in 1978 from Amazonian rubber tree tappers and Indians

A study was carried out to assess the stability of antimicrobial susceptibility of wild isolates upon long-term storage using fifty-three Escherichia coli strains isolated in 1978 from feces of healthy children from the Amazon region in Brazil, exposed to low levels of antimicrobial agents, and examined for resistance to mercury and four antibiotics. All of the strains were kept in Lignieres medium at room temperature and were transferred to fresh media four times during this period. Thirty-five out of the 53 strains analyzed in 1978 were viable. Upon recovery, antibiotic and mercury resistance was estimated. All of the 35 strains maintained their original phenotype in a stable fashion, except for one multiresistant strain which became susceptible to kanamycin. Fifty-four percent of the strains exhibited a resistance phenotype, among which 47% had conjugative plasmids.

A phase III trial of docetaxel/carboplatin versus mitomycin C/ifosfamide/ cisplatin (MIC) or mitomycin C/vinblastine/cisplatin (MVP) in patients with advanced non-small-cell lung cancer : a randomised multicentre trial of the British Thoracic Oncology Group (BTOG1)

Background: Phase III studies suggest that non-small-cell lung cancer (NSCLC) patients treated with cisplatin-docetaxel may have higher response rates and better survival compared with other platinum-based regimens. We report the final results of a randomised phase III study of docetaxel and carboplatin versus MIC or MVP in patients with advanced NSCLC. Patients and methods: Patients with biopsy proven stage III-IV NSCLC not suitable for curative surgery or radiotherapy were randomised to receive four cycles of either DCb (docetaxel 75 mg/m 2, carboplatin AUC 6), or MIC/MVP (mitomycin 6 mg/m 2, ifosfamide 3 g/m 2 and cisplatin 50 mg/m 2 or mitomycin 6 mg/ m 2, vinblastine 6 mg/m 2 and cisplatin 50 mg/m 2, respectively), 3 weekly. The primary end point was survival, secondary end points included response rates, toxicity and quality of life. Results: The median follow-up was 17.4 months. Overall response rate was 32% for both arms (partial response = 31%, complete response = 1%); 32% of MIC/MVP and 26% of DCb patients had stable disease. One-year survival was 39% and 35% for DCb and MIC/MVP, respectively. Two-year survival was 13% with both arms. Grade 3/4 neutropenia (74% versus 43%, P < 0.005), infection (18% versus 9%, P = 0.01) and mucositis (5% versus 1%, P = 0.02) were more common with DCb than MIC/MVP. The MIC/MVP arm had significant worsening in overall EORTC score and global health status whereas the DCb arm showed no significant change. Conclusions: The combination of DCb had similar efficacy to MIC/MVP but quality of life was better maintained. © 2006 European Society for Medical Oncology.

Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment : the M77001 study group

Purpose: This randomized, multicenter trial compared first-line trastuzumab plus docetaxel versus docetaxel alone in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). Patients and Methods: Patients were randomly assigned to six cycles of docetaxel 100 mg/m 2 every 3 weeks, with or without trastuzumab 4 mg/kg loading dose followed by 2 mg/kg weekly until disease progression. Results: A total of 186 patients received at least one dose of the study drug. Trastuzumab plus docetaxel was significantly superior to docetaxel alone in terms of overall response rate (61% v 34%; P = .0002), overall survival (median, 31.2 v 22.7 months; P = .0325), time to disease progression (median, 11.7 v 6.1 months; P = .0001), time to treatment failure (median, 9.8 v 5.3 months; P = .0001), and duration of response (median, 11.7 v 5.7 months; P = .009). There was little difference in the number and severity of adverse events between the arms. Grade 3 to 4 neutropenia was seen more commonly with the combination (32%) than with docetaxel alone (22%), and there was a slightly higher incidence of febrile neutropenia in the combination arm (23% v 17%). One patient in the combination arm experienced symptomatic heart failure (1%). Another patient experienced symptomatic heart failure 5 months after discontinuation of trastuzumab because of disease progression, while being treated with an investigational anthracycline for 4 months. Conclusion: Trastuzumab combined with docetaxel is superior to docetaxel alone as first-line treatment of patients with HER2-positive MBC in terms of overall survival, response rate, response duration, time to progression, and time to treatment failure, with little additional toxicity. © 2005 by American Society of Clinical Oncology.

Dapsone-induced agranulocytosis. The role of xenobiotic-metabolizing enzymes demonstrated by a case report [Dapson-induzierte Agranulozytose]

A 34-year-old female patient with a three year history of generalized granuloma annulare was treated systemically with dapsone (DADPS). Six weeks after the onset of treatment, the patient developed an extensive tonsillitis of the base of the tongue with fever and malaise. Routine laboratory work showed a leukocytopenia with agranulocytosis. Further investigation revealed a marked decrease of the enzyme activity of N-acetyltransferase 2, which plays an important role in dapsone metabolism. Treatment included the cessation of dapsone, antibiotic coverage, and G-CSF leading to the rapid improvement of symptoms and normalization of leukocyte counts. Dapsone-induced angina agranulocytotica is a rare event and is interpreted as an idiosyncratic reaction. Depending on genetic polymorphisms of various enzymes, dapsone can be metabolized to immunologically or toxicologically relevant intermediates. Because of the risk of severe hematologic reactions, dapsone should only be employed for solid indications and with appropriate monitoring. [Article in German]

Cost-effectiveness of a post-splenectomy registry for prevention of sepsis in the asplenic

Background: Overwhelming, sometimes fatal infections represent a lifelong risk after surgical removal of the spleen, or in patients who develop hyposplenism as a consequence of illnesses. This risk may be reduced by all or a combination of vaccination, antibiotic prophylaxis and education. We aimed to determine if a registry approach to delivering these interventions would be cost effective using our own experience and published data.
Method: The decision model compared a cohort of 1,000 people covered by a registry to a cohort of 1,000 people with no registry. The impact of the registry was assessed in terms of achieved rates of vaccination, chemoprophylaxis and education, consequent outcomes of overwhelming post-splenectomy infection (OPSI) and mortality (years of life lived). The cost-effectiveness of the registry compared with no registry was estimated in terms of additional cost per case of OPSI avoided and as additional cost per life year gained.
Results: In the first two years, the additional cost of the registry was $152,611 per case of OPSI avoided or $205,931 per life year gained. After this initial registration period the costeffectiveness improves over time, such that over the cohort lifetime a post-splenectomy register is associated with an additional cost of $105,159 per case of OPSI avoided or $16,113 per life year gained.
Conclusion: A registry-based approach is likely to prove cost effective in terms of mortality and rates of OPSI avoided.

CAMPYLOBACTER EM CAES COM E SEM DIARREIA: INCIDENCIA E SUSCETIBILIDADE A 21 ANTIMICROBIANOS

Two hundred and four stools of 102 diarrheic (0-12 months of age) and 102 non-diarrheic dogs coming from kennel and ambulatory, respectively, were assayed for the presence of Campylobacter. From the diarrhetic group, 46% of the samples yelded positive Campylobacter isolation mainly found in young animals until 5 months of age (72%), whereas those with age ranging from 6-12 months showed either a lower frequence of the organisms (28%) and a trend of the younger animals to be more charged than the older. 47 Campylobacter strains isolated from the diarrheic group were: C. jejuni biotype 1 (49%); C. jejuni biotyp 2 (11%); C. jejuni/coli (19%); C. coli (8,5%); Campylobacter NARTC group (8,5%) and C. sputoruns (4%). In the non-diarrhetic group, 27 (28%) Campylobacter strains were classified as: C. jejuni biotype 1 (34%) and biotype 2 (28%); C. jejuni/coli (24%) and C. coli (14%). According the biochemical tests, the 1% glycine tolerance test was not taking in account for the differentiation of C. jejuni because 45% of the strains failed in showing characteristic and 3 strains did not reduce the sodium selenite. The biochemical studies also showed phenotipical cross reactions between two Campylobacter NARTC-group strains with the C. jejuni strains, as well as two thermophilic species grew also at 25°C. All the 76 isolates were sensitive to gentamicin, nitrofurantoin and neomycin and resistant to oxacillin and penicillin. Furthermore, for the remaining 16 drugs the populational resistance ranged from 8% to 73% of strains. The presence of Campylobacter in dogs as well their close contact which man makes possible the occurrence of infections as also confirm the campylobacteriosis as an important zoonosis.

AVALIACAO DO EFEITO DO VENENO DE APIS MELLIFERA EM CULTURAS DE E. COLI, S. TYPHIMURIUM E Y. ENTEROCOLITICA TRATADAS COM BLEOMICINA

Apis mellifera bee venom (Africanized honey bee) was tested for the ability to protect against the lethal effect of bleomycin, an antibiotic and antineoplastic agent. Since the radioprotective effect of the venom has been observed on the other biological systems, in the present study the venom was applied to cultures of enterobacteria treated with bleomycin, a radiomimetic agent. The venom did not act as a protective agent against bleomycin in E. coli, S. typhimurium or Y. enterocolitica.

Estudo sobre a resistencia aos antimicrobianos em bacterias isoladas de pacientes hospitalizados (Botucatu, 1988-1992)

Since 1988 to 1992, a study about susceptibility to antimicrobial drugs of bacterias isolated from hospitalized patients was performed. The compared susceptibility to important drugs (ampicillin, cephalotin, cefoxitin, ceftaxizime, ceftriaxone, aztreonam, gentamicin, amikacin, pefloxacin, ciprofloxacin, imipenem, oxacillin and vancomycin) was investigated in 1200 strains (300 of each specie) of the prevalent bacterias: E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. aureus. Minimal inhibitory concentration (MIC) was determined by agar dilution method, using from 0.05 to 256 mcg of each drug per ml of culture medium (Mueller-Hinton). Ranges of MIC, MIC(50%), MIC(90%) and the proportion of resistant strains were determined and permitted to know the 4 drugs that were found to be more active against bacterias; the CIM(90%) values are: E. coli - aztreonam (0.1 mcg/ml), pefloxacin (0.1), ceftazidime (0.25) and ceftriaxone (0.05); K. pneumoniae-aztreonam (0.25) ceftriaxone (0.25), ceftazidime (0.5) and pefloxacin (2.0); P. aeruginosa-imipenem (4.0), aztreonam (16), ceftazidime (16) and ciprofloxacin (16); S. aureus-vancomycin (1.01, ciprofloxacin (8, 0), amikacin (128) and cephalothin (128 mg/ml). The better 'in vitro' antibacterial activity observed was related to: aztreonam (77-100% of the sensitive strains), ceftazidime (50-99,7%), pefloxacin (73-99,7%), ciprofloxacin (80%), imipenem (93%) and vancomycin (100%).

FATORES RELACIONADOS COM A OCORRENCIA E EVOLUCAO DAS ENDOFTALMITES

We retrospectively analysed 33 endophthalmitis patients treated at the Faculdade de Medicina de Botucatu. We observed that 81,8% of these patients were males and older than 60 years. Trauma was the main cause of endophthalmitis (42,4%). Endophthalmitis severity can be assessed by the fact there was no improvement on the final visual acuity.

Fermentacao de 26-deoxilaidlomicina por Streptomyces sp. Ar386

In a previous work a strain of microorganism was isolated in Araraquara region, SP, Brazil, and characterized as being Streptomyces sp. Ar386, producer of 26-deoxylaidlomycin and of more three polietheric antibiotics. In this paper there are presented studies about fermentation characteristics of the antibiotic performed in incubator agitator utilizing various cultivation technics and media. A medium containing part of energy source as free sugar and part as amilaceous material presented the best result. As the Streptomyces sp. Ar386 produced few spores, it was necessary special care to provide sufficient quantity of microorganisms in inoculation. The biosynthesis of antibiotics intensified between the forth and seventh day. The yields varied from 8 to 443 mg of antibiotic complex per litre of medium. As a polyether antibiotic it may be used as anticoccidal agent in poultry and as growth promoters in cattle and swine.

Lipossomas: Estrategia biotecnologica para liberacao controlada e direcionamento intracelular de farmacos com efeito antimicobacteriano

This text highlights the state of research related with the application of liposomes in the control of drug delivery and drug target to intracellular bacterial diseases, such as the tuberculosis. Liposome have several pharmaceutical applications and this article is primarily focused on the potential of this agregate on drug encapsalation especially antimycobacterial compounds. Case studies in which liposomes have successfully been used to improve pharmacological drug effect are presented. Mechanisms involved in intracellular drug delivery, possibilities of application, research and development efforts to address these objectives are discussed.