Allan J. Weinstein

Bilateral emphysematous pyelonephritis

Emphysematous pyelonephritis is a severe infection found almost exclusively in diabetics, characterized by the presence of gas within the renal parenchyma. The diagnosis is established radiographically. An additional case is added to the 52 cases reported in the literature; we believe this is the fifth reported case with bilateral emphysematous pyelonephritis. If appropriate diagnostic studies demonstrate no evidence of either perinephric abscess or urinary obstruction, intensive medical management should be the initial therapy for this condition. Surgical intervention is necessary in patients without prompt response to medical therapy.

Unusual Serum Lipoprotein Abnormality Induced by the Vehicle of Miconazole

Miconazole, a phenethylimidazole,1 is effective in vitro against several pathogenic fungi,1 , 2 and has cured systemic mycoses in man.3 , 5 In contrast to amphotericin B, miconazole does not appear...

Penicillin-Tobramycin Synergism Against Enterococci: a Comparison with Penicillin and Gentamicin

Combinations of penicillin plus tobramycin have been compared with penicillin plus gentamicin against 27 strains of enterococci isolated from blood cultures. Penicillin plus gentamicin was synergistic against all strains. The combination of penicillin plus tobramycin was equally effective against strains of Streptococcus facalis, but was ineffective against all four strains of S. faecium tested.

The Cephalosporins: Activity and Clinical Use

SummaryThe cephalosporin antibiotics have been employed with increasing frequency since their introduction into clinical practice in the early 1960s. With the exception of cephaloridine, cephalosporin compounds are not associated with the production of significant untoward effects. The availability of newer cephalosporins, both oral and parenteral, with enhanced antibacterial activity, has expanded the clinical indications for administration of these antibiotics.

Studies of Cephalothin: Aminoglycoside Synergism Against Enterococci

Combinations of cephalothin and aminoglycoside antibiotics are not currently used in the therapy of serious enterococcal infections, because clinical trials of these combinations have been unsuccessful. Studies of 28 enterococci isolated from patients with enterococcal bacteremia suggested three possible mechanisms for this in vivo antibiotic failure: (i) a relatively high level of resistance to cephalothin among all enterococci and especially those characterized as Streptococcus faecium, (ii) a significant incidence of high-level resistance to the aminoglycosides among certain strains of enterococci, and (iii) a failure of synergism to occur when cephalothin concentrations fall below the minimal inhibitory concentration of the enterococcus, as occurs during the in vivo metabolism and excretion of this antibiotic when given in standard doses for endocarditis.

Cephalosporin-Aminoglycoside Synergism in Experimental Enterococcal Endocarditis

Despite in vitro demonstrations of synergism against enterococci, combinations of cephalosporin and aminoglycoside antibodies have been ineffective in the therapy of enterococcal endocarditis. Penicillin-gentamicin, cephalothin-gentamicin, and cefazolin-gentamicin were used to treat enterococcal endocarditis in rabbits. A direct relation was observed between the rate of cure and the degree by which the peak serum concentration of penicillin and the cephalosporins exceeded the minimal inhibitory concentration of the enterococcus. Thus, cephalosporin doses which produce serum concentrations which exceed the minimal inhibitory concentration of the enterococcus by several orders of magnitude may, in combination with aminoglycosides, be effective in treating human enterococcal endocarditis.

Tobramycin Concentrations During Peritoneal Dialysis

A patient undergoing peritoneal dialysis for severe renal failure was treated with tobramycin. Peritoneal dialysis was inefficient in removing tobramycin from the serum. Tobramycin concentrations in the dialysis effluent were low. Despite acute oliguric renal failure, urine concentrations of tobramycin were sufficient to treat most gram-negative urinary tract infections.

Treatment of Bacterial Infections in Pregnancy

SummaryTreatment of bacterial infections in pregnancy requires an understanding of the unique problems related to the administration of antibacterial agents to pregnant women. The clinician must be aware not only of the antibiotic-associated untoward effects which may develop in the mother, but also of the possibility that adverse reactions may occur in the fetus. Precise knowledge of the microbial aetiology of those infections which occur during pregnancy and an understanding of the intricacies of antibiotic administration to pregnant women will assure the greatest likelihood that bacterial infections in pregnancy will be effectively, and safely, treated.

Penicillinase-Resistant Penicillins Plus Gentamicin in Experimental Enterococcal Endocarditis

Previous in vitro studies demonstrating that the penicillinase-resistant penicillins act synergistically in combination with gentamicin against some enterococci have suggested that these combinations might be effective therapy for enterococcal infections in vivo. To determine the in vivo effectiveness of such combinations, we treated rabbits with enterococcal endocarditis with gentamicin and either nafcillin, oxacillin, or methicillin. Despite doses of the penicillins equivalent to 12 or 24 g/day in a 70-kg patient, the percentage of animals in each treatment group with sterile valves at autopsy after spontaneous death or sacrifice after 21 days of therapy was low. High-dose therapy with the penicillins did not significantly increase survival over the low-dose treatment groups. Thus, it seems prudent to include penicillin with a penicillinase-resistant penicillin and gentamicin as the initial therapy of patients with endocarditis possibly caused by enterococci.