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Scandinavian Journal of Infectious... 1995A few days after a mild trauma to a toe, a 90-year-old woman presented with fever, malaise and cellulitis. On suspicion of erysipelas the patient was initially treated...
A few days after a mild trauma to a toe, a 90-year-old woman presented with fever, malaise and cellulitis. On suspicion of erysipelas the patient was initially treated with benzylpenicillin and cefuroxime. Her general condition improved rapidly, but there was local progression with numerous necrotic areas with surrounding bullae. Vibrio vulnificus was isolated from the blood. After susceptibility testing, the patient was finally treated with ciprofloxacin and pivampicillin, and recovered slowly. To our knowledge, this is the first reported case of bacteremia with V. vulnificus in Sweden.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Female; Humans; Sweden; Vibrio; Vibrio Infections; Wound Infection
PubMed: 7784822
DOI: 10.3109/00365549509018980 -
British Journal of Obstetrics and... Jul 1994To investigate the incidence of post-operative infection after first trimester abortion in women treated with a long-acting cephalosporin (ceftriaxone) compared with low... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
OBJECTIVE
To investigate the incidence of post-operative infection after first trimester abortion in women treated with a long-acting cephalosporin (ceftriaxone) compared with low risk patients receiving no treatment and with high risk patients receiving our standard treatment of ampicillin/pivampicillin and metronidazole.
DESIGN
A prospective, randomised controlled trial.
SETTING
Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark.
SUBJECTS
Nine hundred and ninety-six women, admitted on an outpatient basis for legal termination of pregnancy at 12 weeks or less of gestation, were included in the study after giving informed consent. The women were divided into high risk and low risk categories and allocated either to treatment with ceftriaxone or to standard treatment. For high risk patients the standard treatment was initiated by a peroperative injection of ampicillin and metronidazole, followed by oral doses of metronidazole and pivampicillin three times daily for four days. No prophylactic antibiotics were given to the women randomised to standard treatment in the low risk group.
INTERVENTIONS
All women were kept under observation, and, between six and 14 days postoperatively, underwent pelvic examination. Clinical endpoints were noted.
MAIN OUTCOME MEASURES
Post-operative pelvic inflammatory disease in women applying for legal first trimester abortion.
RESULTS
Seven hundred and eighty-six women fulfilled the criteria for evaluation. A tendency toward a prophylactic effect of ceftriaxone was observed in most clinical findings. A significant prophylactic effect of ceftriaxone was found in the low risk group.
CONCLUSIONS
This study demonstrated a significant reduction in post-operative pelvic inflammatory disease in low risk patients, who were applying for legal first trimester abortion, treated peroperatively with ceftriaxone. No significant difference was demonstrated between high risk patients treated with ceftriaxone or ampicillin/pivampicillin and metronidazole.
Topics: Abortion, Induced; Adolescent; Adult; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Pelvic Inflammatory Disease; Pregnancy; Prospective Studies; Vacuum Curettage
PubMed: 8043540
DOI: 10.1111/j.1471-0528.1994.tb13652.x -
Tidsskrift For Den Norske Laegeforening... May 1994Long-term treatment with pivampicillin and pivmecillinam for 6-24 months in five adults and one child reduced the total serum carnitine concentrations to 3.7-14.0...
Long-term treatment with pivampicillin and pivmecillinam for 6-24 months in five adults and one child reduced the total serum carnitine concentrations to 3.7-14.0 mumol/l (reference value 25-66 mumol/l). The muscle carnitine was reduced to 0.3-0.7 mumol/g wet weight (reference value 3-5 mumol/g) in two cases. All patients had asthenia and muscle symptoms with weakness and pain. One showed signs of carnitine depletion in the liver, with increased secretion of dicarboxylic acids (C6, C8, C10) in urine and limited ketone body formation during prolonged fasting (32 hours). The serum carnitine increased slowly after cessation of therapy and reached normal concentrations after 6-12 months. All symptoms caused by carnitine depletion disappeared after the serum carnitine reached 20 mumol/l. This was achieved on a normal diet without carnitine supplement.
Topics: Adult; Aged; Amdinocillin Pivoxil; Carnitine; Child; Female; Humans; Male; Pivampicillin; Time Factors
PubMed: 8079264
DOI: No ID Found -
The Veterinary Quarterly May 1994The plasma disposition of ampicillin after intravenous administration at a dose rate of 15 mg/kg was studied in six healthy, 1-month-old foals. The oral bioavailability...
The plasma disposition of ampicillin after intravenous administration at a dose rate of 15 mg/kg was studied in six healthy, 1-month-old foals. The oral bioavailability of pivampicillin was determined in the same foals at four ages, ranging from 11 days to 4 months. Pivampicillin was administered orally at a dose rate of 19.9 mg/kg, which is equivalent on a molecular basis to 15 mg/kg ampicillin. Ampicillin concentrations in plasma were determined up to 12 hours after administration. After intravenous administration, the mean distribution and elimination half-lives of ampicillin were 0.121 and 0.624 h, respectively. The volume of distribution (Vss) appeared to be 0.334 l/kg. Orally administered pivampicillin was rapidly absorbed in all age groups, producing mean peak plasma concentrations of 3.83 to 5.69 micrograms/ml 1 h after administration. The mean bioavailability of pivampicillin in the different age groups ranged from 39.4 to 52.9%. There was no statistically significant difference in peak plasma concentration or bioavailability between the age groups. It is concluded that pivampicillin at a dose rate of 19.9 mg/kg orally gives satisfactory plasma concentrations in foals of all ages.
Topics: Administration, Oral; Animals; Biological Availability; Female; Horses; Injections, Intravenous; Male; Pivampicillin
PubMed: 7801502
DOI: No ID Found -
The British Veterinary Journal 1994Ampicillin is an antibiotic commonly administered to horses by both the intramuscular (i.m.) and the intravenous (i.v.) route. Its physicochemical properties restrict... (Review)
Review
Ampicillin is an antibiotic commonly administered to horses by both the intramuscular (i.m.) and the intravenous (i.v.) route. Its physicochemical properties restrict its absorption after oral administration and explain its rapid elimination from the body. To prolong the effects of ampicillin in the horse, attempts have been made to alter its elimination and absorption rates. The alteration of urinary pH did not change the plasma disposition of the antibiotic but when probenecid was administered concurrently with ampicillin, a significant reduction of total body clearance was achieved. Ampicillin may also be maintained in the equine body, for a prolonged period of time when administered as an i.v. infusion. However, the practical difficulties associated with this route of administration and the limited potential advantage over conventional routes such as i.m. injection restrict its application to the critically ill animal and the perioperative period. When bacampicillin and pivampicillin (two ampicillin prodrugs) were administered to horses, high oral bioavailability was obtained, and the use of prodrugs commands the need for further investigation. The use of ampicillin might be limited in the future as an increase in the number of resistant equine bacterial strains emerge and it may be prudent to restrict its use according to the principles of good clinical pharmacological practice.
Topics: Ampicillin; Ampicillin Resistance; Animals; Bacteria; Horses; Pivampicillin; Prodrugs
PubMed: 8025849
DOI: 10.1016/S0007-1935(05)80225-8 -
Xenobiotica; the Fate of Foreign... Nov 19931. To evaluate the effectiveness of carnitine administration in aiding the elimination of pivalate liberated from pivampicillin, studies were undertaken on seven...
1. To evaluate the effectiveness of carnitine administration in aiding the elimination of pivalate liberated from pivampicillin, studies were undertaken on seven paediatric patients treated for 7 days with combined pivampicillin and molar excess of carnitine. 2. A 22-fold increase occurred in urinary carnitine ester excretion on the last day of treatment (2967 +/- 604 versus 134 +/- 50 mumol/day, p < 0.05); the pivaloylcarnitine was identified with 13C-n.m.r. Only pivalate was detected in the urinary carnitine ester g.l.c. profile, the amount of this ester was equal to 92% of the daily pivalate intake. 3. The renal clearance rate of carnitine esters significantly exceeded that of creatinine indicating that the carnitine ester was eliminated by active transport. 4. The plasma concentration and urinary output of free carnitine were not changed significantly by the treatment, and the free and esterified carnitine concentrations in red cells remained unchanged indicating that carnitine deficiency was prevented.
Topics: Adolescent; Carnitine; Child; Chromatography, Gas; Drug Interactions; Esters; Female; Humans; Magnetic Resonance Spectroscopy; Male; Pentanoic Acids; Pivampicillin
PubMed: 8310709
DOI: 10.3109/00498259309059436 -
Pharmacy World & Science : PWS Oct 1993Long-term treatment with pivampicillin and pivmecillinam for 6-24 months in five adults and one child reduced the total serum carnitine concentration to 3.7-14 mumol/l...
Long-term treatment with pivampicillin and pivmecillinam for 6-24 months in five adults and one child reduced the total serum carnitine concentration to 3.7-14 mumol/l (reference value: 25-66 mumol/l). Muscle carnitine was reduced to 0.3-0.7 mumol/g wet weight (reference value: 3-5 mumol/g) in two cases. All patients had muscle symptoms with weakness, asthenia and pains. One showed signs of carnitine depletion in the liver with increased secretion of dicarboxylic acids (C6, C8, C10) in urine and limited ketone body formation during prolonged fasting. Serum carnitine increased slowly after cessation of therapy and reached normal concentrations after 6-12 months. All symptoms caused by carnitine depletion disappeared. This was achieved on a normal diet without carnitine supplementation.
Topics: Adult; Aged; Aged, 80 and over; Amdinocillin Pivoxil; Carnitine; Child; Female; Humans; Male; Pivampicillin; Time Factors; Vitamin B Deficiency
PubMed: 8257960
DOI: 10.1007/BF01880631 -
Pediatric Research Oct 1993Plasma concentrations and rates of urinary excretion of carnitine and some of its precursors were studied in three groups of children receiving drugs known to cause...
Plasma concentrations and rates of urinary excretion of carnitine and some of its precursors were studied in three groups of children receiving drugs known to cause carnitine depletion. Patients in group A received pivampicillin and a molar equivalent of carnitine for 7 d. Patients in group B received pivampicillin with a 5.8-fold molar excess of carnitine for 1 wk. Patients in group C were treated chronically with valproic acid and received a molar equivalent (to valproic acid) of carnitine for 14 d. Patients in group A had markedly increased (16-fold) urinary carnitine ester excretion concomitant with diminished urinary free carnitine and gamma-butyrobetaine output and lower plasma free carnitine concentration. Supplementation with one molar equivalent of carnitine (to pivampicillin) was ineffective in preventing the reduction of plasma carnitine concentration observed with pivampicillin treatment alone. For group B patients, administration of excess carnitine resulted in a further increase (35-fold) of urinary carnitine ester output with no decrease of plasma carnitine concentration, urinary gamma-butyrobetaine, or free carnitine excretion. For patients in group C, the initially low plasma free and total carnitine concentrations and urinary output of carnitine and carnitine esters markedly increased with carnitine supplementation, but urinary excretion of gamma-butyrobetaine remained unchanged. The plasma concentrations and urinary output of L-lysine and epsilon-N-trimethyllysine remained unchanged within each group before and after treatment. A positive linear correlation was found between urinary epsilon-N-trimethyllysine and 3-methylhistidine output, indicating that the rate of epsilon-N-trimethyllysine excretion correlates with the amount of 3-methylhistidine liberated by protein turnover.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adolescent; Bacteriuria; Betaine; Carnitine; Child; Child, Preschool; Creatinine; Epilepsy; Female; Humans; Lysine; Male; Pivampicillin; Urinary Tract Infections; Valproic Acid
PubMed: 8255678
DOI: 10.1203/00006450-199310000-00015 -
Tidsskrift For Den Norske Laegeforening... Jan 1993Clinical diagnosis can often indicate whether the patient has an infection of the lower or the upper urinary tract. The symptoms may be misleading, however. Examination...
Clinical diagnosis can often indicate whether the patient has an infection of the lower or the upper urinary tract. The symptoms may be misleading, however. Examination of the urine is therefore essential. Recommendations are made for sampling, microscopy, stix-tests and interpretation of cultures. Species distribution and sensitivity patterns are presented. There has been a trend towards increasing antimicrobial resistance during the period 1982 to 1990. The recommended drugs for uncomplicated infections of the lower urinary tract in women include nitrofurantoin, amoxicillin, pivampicillin, pivmecillinam, sulfamethizole, trimethoprim and co-trimoxazole, with a possible preference for trimethoprim and nitrofurantoin (should be used with caution in elderly patients). Duration of therapy is normally three days. In pregnant women and in men with an infection of the lower urinary tract the duration of treatment should be 7-10 days. Specific drugs are recommended for these groups of patients. Drugs recommended for infection of the upper urinary tract and complicated infections of the lower urinary tract include amoxicillin, ampicillin, ciprofloxacin/ofloxacin, co-trimoxazole, pivampicillin and pivmecillinam. Duration of treatment should be 7-10 days. Treatment is also recommended for reinfection, for children, for patients with asymptomatic bacteriuria and for patients with permanent bladder catheters. Long-term prophylaxis and general advice on lifestyle are also discussed.
Topics: Anti-Bacterial Agents; Family Practice; Female; Humans; Male; Sulfonamides; Trimethoprim; Urinary Tract Infections
PubMed: 8435104
DOI: No ID Found -
Infection 1993To evaluate the absorption and tolerability of a new formulation of pivampicillin administered as a 700 mg tablet, 14 healthy volunteers received single doses of 350,... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
To evaluate the absorption and tolerability of a new formulation of pivampicillin administered as a 700 mg tablet, 14 healthy volunteers received single doses of 350, 500 and 700 mg p.o. Maximum serum concentrations (Cmax) of 5.73, 7.05 and 8.61 mg/l were obtained. The corresponding values for the area under the concentration/time curve (AUC) were 12.32, 18.99 and 25.30 mg/lxh. Concomitant intake of food increased the Cmax of the 700 mg tablet to 9.5 mg/l, while the AUC remained unchanged. Co-administration of the 700 mg pivampicillin dose with an antacid reduced the Cmax to 7.45 mg/l and the AUC to 17.92 mg/l x h. The tolerance of the 700 mg tablet was evaluated in a double-blind placebo-controlled study involving 57 patients. Six percent of the patients in each treatment group reported minor adverse reactions.
Topics: Adolescent; Adult; Dose-Response Relationship, Drug; Drug Tolerance; Female; Humans; Intestinal Absorption; Male; Middle Aged; Pivampicillin; Surveys and Questionnaires; Tablets
PubMed: 8449578
DOI: 10.1007/BF01739307