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Postgraduate Medical Journal Nov 1992A 51 year old female developed a skeletal muscle myopathy after 3 months of pivampicillin therapy. Pivampicillin can cause carnitine deficiency due to the pivalic acid...
A 51 year old female developed a skeletal muscle myopathy after 3 months of pivampicillin therapy. Pivampicillin can cause carnitine deficiency due to the pivalic acid side group. Plasma carnitine content and the patients symptoms failed to improve significantly on discontinuing the drug. Oral carnitine replacement therapy was administered for 6 weeks but the patient's plasma carnitine levels responded only slowly to this treatment. It is suggested that pivampicillin inhibits uptake of carnitine from the gut and may either directly or indirectly depress endogenous carnitine synthesis. In such cases a more aggressive carnitine replacement regime is indicated and pivampicillin should be avoided in patients requiring long-term antibiotic administration.
Topics: Carnitine; Drug Administration Schedule; Female; Humans; Middle Aged; Muscular Diseases; Pivampicillin
PubMed: 1494519
DOI: 10.1136/pgmj.68.805.932 -
Ugeskrift For Laeger Oct 1992The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were... (Review)
Review
The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.
Topics: Abortion, Induced; Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Infertility, Female; Pregnancy; Pregnancy Complications, Infectious; Premedication; Risk Factors; Surgical Wound Infection
PubMed: 1462401
DOI: No ID Found -
Biochemical Pharmacology Sep 1992Pivampicillin (630 mg/kg body wt) given daily by stomach tube induced carnitine deficiency in the rat. The carnitine concentrations after 24 days were significantly...
Pivampicillin (630 mg/kg body wt) given daily by stomach tube induced carnitine deficiency in the rat. The carnitine concentrations after 24 days were significantly reduced to (mean +/- SD) 34 +/- 2, 27 +/- 7, 70 +/- 18, 75 +/- 16 and 49 +/- 4% of controls in plasma, liver, muscle, heart and kidney, respectively, without any further reduction after 36 days. Pivampicillin treatment reduced the carnitine concentrations in the liver of the 48 hr fasted rat to about 1/2 of the controls after 6 days. The concentration of beta-hydroxybutyrate was significantly reduced up to 14 days of treatment, and again increased. There was no significant difference in the free fatty acid concentrations between treated and control rats. Thus, pivampicillin treatment induced carnitine deficiency in the rat, but not as pronounced as seen in humans. This is possibly caused by adjustment of bacterial flora in the gut or altered renal mechanisms. The pivampicillin-treated rat, therefore, is not a useful model for pronounced carnitine deficiency in humans.
Topics: Animals; Carnitine; Fatty Acids; Ketone Bodies; Kidney; Liver; Male; Models, Biological; Muscles; Myocardium; Pivampicillin; Rats; Rats, Wistar
PubMed: 1417946
DOI: 10.1016/0006-2952(92)90391-u -
Scandinavian Journal of Clinical and... Sep 1992Treatment of 17 children aged 2-9.5 years with a combination of pivmecillinam and pivampicillin (250-500 mumol 24 h-1) for more than 1 year resulted in a reduction of...
Treatment of 17 children aged 2-9.5 years with a combination of pivmecillinam and pivampicillin (250-500 mumol 24 h-1) for more than 1 year resulted in a reduction of the free carnitine concentration in serum and muscle to less than 10% of the mean reference value. The decline in serum was slow, with an estimated half-life of about 5 months. Spontaneous replenishment occurred at about the same slow rate. Thus, there is no increase in endogenous carnitine synthesis as a response to increased demand of carnitine for detoxification. Supplementation with carnitine during treatment required at least a four-fold molar excess over pivalic acid to achieve and sustain a normal carnitine concentration. The replenishment of carnitine occurred with a half-life of 1.1-3.0 months. From determination of muscle-carnitine concentration in patients treated with pivaloyl-containing antibiotics and in patients with organic aciduris, we conclude that serum carnitine is a good predictor of carnitine stores in the body. Six non-supplemented patients with a serum free-carnitine concentration of 0.7-2.6 mumol l-1 had an inadequate ketone-body increase during a 24-h fast. Vomiting, nausea and tiredness occurred in three cases following the fasting period. After normalization of the serum-carnitine concentration, a normal response to fasting was observed. Thus, in some organic acidurias, for example medium-chain acyl-CoA dehydrogenase deficiency, a low liver concentration of carnitine may be an important contributing factor to hypoglycaemic and Reye-like attacks. We believe that prodrugs which contain pivalic acid should be avoided if acceptable alternatives exist. If used, supplementation with at least four-fold molar excess of carnitine is advisable.
Topics: Amdinocillin Pivoxil; Carnitine; Child; Child, Preschool; Fasting; Female; Homeostasis; Humans; Muscles; Pentanoic Acids; Pivampicillin; Prodrugs; Reference Values
PubMed: 1514015
DOI: 10.3109/00365519209088371 -
Journal of Veterinary Pharmacology and... Sep 1992The pharmacokinetics of ampicillin and amoxicillin following intravenous administration at a dose rate of 15 and 10 mg/kg respectively were studied in four healthy adult... (Comparative Study)
Comparative Study
The pharmacokinetics of ampicillin and amoxicillin following intravenous administration at a dose rate of 15 and 10 mg/kg respectively were studied in four healthy adult horses. Pharmacokinetics of pivampicillin and amoxicillin were studied after oral administration to four healthy adult horses. Pivampicillin, a prodrug of ampicillin, was administered orally to starved and fed horses at a dose rate of 19.9 mg/kg, which is equivalent on a molecular basis to 15 mg/kg ampicillin. Amoxicillin was administered orally to starved horses only, at a dose rate of 20 mg/kg. Ampicillin and amoxicillin concentrations in plasma, synovial fluid and urine were determined. Mean biological half-life of intravenously administered ampicillin and amoxicillin was 1.72 and 1.43 h respectively, whilst the distribution volume (Vss) appeared to be 0.180 and 0.192 1/kg. Orally administered pivampicillin and amoxicillin were rapidly absorbed. A maximum concentration in plasma of 3.80 micrograms/ml was reached 2 h after administration of pivampicillin to starved horses; in fed horses a maximum concentration of 5.12 micrograms/ml was reached 1 h after administration. After oral administration of amoxicillin a maximum concentration of 2.03 micrograms/ml was reached after 1 h. The (absolute) bioavailability of pivampicillin administered orally was 30.9% in starved horses and 35.9% in fed horses. The bioavailability of amoxicillin administered orally was 5.3% in starved horses.
Topics: Administration, Oral; Amoxicillin; Ampicillin; Animals; Biological Availability; Fasting; Female; Half-Life; Horses; Injections, Intravenous; Male; Pivampicillin
PubMed: 1433484
DOI: 10.1111/j.1365-2885.1992.tb01010.x -
Alimentary Pharmacology & Therapeutics Jun 1992
Topics: Bismuth; Humans; Kidney Diseases; Organometallic Compounds; Pivampicillin
PubMed: 1600056
DOI: No ID Found -
Contact Dermatitis May 1992
Topics: Amdinocillin Pivoxil; Cross Reactions; Dermatitis, Contact; Dermatitis, Occupational; Facial Dermatoses; Hand Dermatoses; Humans; Patch Tests; Penicillins; Pivampicillin
PubMed: 1395602
DOI: 10.1111/j.1600-0536.1992.tb00134.x -
Antimicrobial Agents and Chemotherapy May 1992Eight healthy volunteers received a 1,000-mg single oral dose of 2085P which consisted of 800 mg of pivampicillin and 200 mg of brobactam. Concentrations of ampicillin...
Eight healthy volunteers received a 1,000-mg single oral dose of 2085P which consisted of 800 mg of pivampicillin and 200 mg of brobactam. Concentrations of ampicillin and brobactam in plasma, inflammatory fluid, and urine were measured over the subsequent 24 h. Pivampicillin and brobactam were moderately rapidly absorbed. The mean (standard deviation) maximum concentration in plasma (Cmax) of ampicillin was 8.2 (1.9) micrograms/ml, and that of brobactam was 2.1 (2.0) micrograms/ml at mean times of 1.9 (0.5) and 2.3 (0.8) h, respectively. The elimination half-lives in plasma were 1.8 (0.5) and 1.6 (2.0) h, respectively. Both agents penetrated the experimentally induced inflammatory fluid, reaching a mean maximum at 3 h. The Cmax of ampicillin was 6.8 (2.3) micrograms/ml, and that of brobactam was 1.0 (0.4) micrograms/ml. The penetration (derived by comparing the area under the concentration-time curve from 0 h to infinity for inflammatory fluid with that for plasma) was 97.3% (26.0%) for ampicillin and 81% (22.3%) for brobactam. The 24-h urinary recovery was 54.2% (16.6%) of the administered dose for ampicillin and 40.2% (11.4%) for brobactam. These data suggest that this combination of beta-lactam and inhibitor should be efficacious in treating infections caused by ampicillin-resistant pathogens.
Topics: Administration, Oral; Adult; Ampicillin; Drug Therapy, Combination; Humans; Male; Penicillanic Acid; Pivampicillin; beta-Lactamase Inhibitors
PubMed: 1324634
DOI: 10.1128/AAC.36.5.1002 -
Acta Obstetricia Et Gynecologica... May 1992We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic...
We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic diagnosis of advanced ectopic gestation may be difficult, the possibility of ectopic pregnancy should be considered in cases of unsuccessful attempts of induced abortion.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Female; Humans; Oxytocin; Pregnancy; Pregnancy, Tubal; Prostaglandins E, Synthetic; Ultrasonography, Prenatal; Uterine Rupture
PubMed: 1322630
DOI: 10.3109/00016349209021061 -
Gastroenterology Dec 1991To elucidate the pathogenesis of antibiotic-associated diarrhea, colonic carbohydrate fermentation was investigated in three groups of subjects--a group of controls, a...
To elucidate the pathogenesis of antibiotic-associated diarrhea, colonic carbohydrate fermentation was investigated in three groups of subjects--a group of controls, a group of patients with antibiotic-associated diarrhea, and a group of patients receiving antibiotic therapy without diarrhea. Compared with controls, the colonic fermentation was markedly impaired in patients with antibiotic-associated diarrhea reflected by both very low concentrations (22.1 vs. 59.5 mmol/L; P less than 0.01) and production rates of short-chain fatty acids. In the group of patients without diarrhea, the effect on the colonic fermentation was dependent on the antibiotic administered. Penicillin and pivampicillin PO did not reduce the concentrations (69.9 and 66.7 mmol/L, respectively) or production rates. Dicloxacillin, erythromycin, and combined IV treatment with ampicillin, netilmicin, and metronidazole reduced both concentrations (27.1, 38.2, and 18.8 mmol/L; P less than 0.01) and production rates of short-chain fatty acids to levels seen in patients with diarrhea. L-Lactate and D-lactate concentrations were normal in all patients (less than 5 mmol/L), but lactate production was reduced in the patients who had reduced production of short-chain fatty acids, including patients with diarrhea. Thus, antibiotic-associated diarrhea was always related to reduced fecal concentrations and production rates of short-chain fatty acids and production rates of lactate. These results suggest that the antibiotic-associated diarrhea might be secondary to impaired colonic fermentation in otherwise disposed subjects, resulting in accumulation of luminal carbohydrate and/or decreased short-chain fatty acid-stimulated sodium and water absorption.
Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Anti-Bacterial Agents; Colon; Diarrhea; Fatty Acids, Volatile; Feces; Female; Fermentation; Humans; Lactates; Lactic Acid; Male; Middle Aged; Prospective Studies
PubMed: 1955116
DOI: 10.1016/0016-5085(91)90384-w