Concentrations plasmatiques et articulaires pendant l'administration de céfacétrile pour arthrite septique (6 cas) [Serum and joint levels of cefacetrile during its administration for septic arthritis]

Six patients, five of whom had normal and one impaired renal function, and all suffering from purulent arthritis caused by cephalosporin-sensitive germs, were given a seven-day course of 8 g cephacetrile daily. On the first day, 6 g were administered by continuous intravenous infusion at the rate of 500 mg/h, followed by 2 g over a further 45 min. On days 2 to 7, the patients received 2 short infusions of 4 g each at an interval of 12 h. In four patients with normal renal function, serum half-life ranged from 0.8 to 1.4 h, serum levels during continuous infusion from 19 to 31 microgram/ml, and total clearances from 265 to 434 ml/min. In one patients, these values were 1.6 h, 70 microgram/ml and 131 ml/min respectively (small volume of distribution). The concentrations in the synovial fluid varied from 2 to 29 mcirogram/ml; they were generally lower than the serum levels, but clearly exceeded the minimum inhibitory concentrations for germs commonly present in purulent arthritis. In five patients, the synovial fluid became germ-free and the arthritis was clinically cured. In the case presenting with renal insufficiency, the serum half-life was 5.8 h. During continuous administration, a steady state was not attained; peak serum levels amo9nted to 75 microgram/ml and the total clearance to 61 ml/min. The cephacetrile concentrations in the synovial fluid were very high (26 and 67 microgram/ml). In this case, in which the renal insufficiency associated with mycosis fungoides was present before the treatment, renal function deteriorated futher during treatment while the arthritis improved.

[Installation du cénotaphe sous l'Arc de triomphe à l'occasion de la fête de la Victoire] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54816

[Installation des pylônes commémoratifs dans le cadre de la fête de la Victoire avenue des Champs-Élysées] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54826

[Installation du cénotaphe sous l'Arc de Triomphe dans le cadre de la fête de la Victoire] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54825

[Installation du cénotaphe sous l'Arc de triomphe à l'occasion de la fête de la Victoire] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54822

[Installation du cénotaphe sous l'Arc de triomphe à l'occasion de la fête de la Victoire] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54819

[Installation du cénotaphe sous l'Arc de triomphe à l'occasion de la fête de la Victoire] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54814

Prise en charge initiate du sepsis sévère et du choc septique [Management of severe sepsis and septic shock].

Severe sepsis and septic shock are systemic manifestations of the host response to infection. Mortality remains high despite advances in pathophysiological knowledge. Hemodynamic and respiratory management is largely supportive, while early antibiotics administration and source of infection's control are crucial for patient outcome. We review the principles guiding the initial management of these patients in emergency situation.