Giornale italiano di chemioterapia最新文献

Availability of new fluorinated quinolones offers, in the hospital setting, the opportunity to change, in many circumstances, parenteral therapy with oral administration of drugs. This possibility must always depend upon medical considerations, but permits a cost-containment policy with a drastic reduction of hospitalization and therapeutic costs. As far as the latter is concerned a daily cost reduction of 70000-16000 lire is foreseeable.

The Authors report the results obtained in the treatment of bronchopulmonary infections in patients hospitalized in the Neurosurgical Intensive Care Unit. Netilmicin was administered by systemic and endobronchial routes. The cleaning of the bronchial tree was always performed. Twenty-six patients (16 males and 10 females) were enrolled and assigned to one of the following groups. Group A: 16 patients with confirmed pneumonia; Group B: 10 patients without bronchopulmonary infections, as controls for serum pharmacokinetic study. In the majority of the cases pneumonia was caused by Staphylococcus aureus and Pseudomonas aeruginosa. The results obtained were positive: pneumonia resolution was observed in 10 patients (67%), improvement in 4 (27%) and failure in one case (6%). A pharmacokinetic study has confirmed bacteriologically active serum levels of netilmicin and also the availability of netilmicin within the bronchial secretions. Endobronchial plus systemic netilmicin administration was active and well tolerated in these critical patients.

The epidemiological model Eskimo has been utilized to simulate some epidemiological parameters relative to tuberculosis in a restricted geographical area of northern Italy. After having identified a series of features relative to the regimens applied in the area in the period 1982-86 and which were found to be compatible with the observed data, this hypothesis has been utilized to project data on tuberculosis for the period 1986-1996. The results have indicated that the incidence in the area should stabilize around values of 20 new cases per year (per 100,000 population). A decrease in the incidence can be expected to occur only if the regimens so far employed are brought to a greater part of the patients' population (increasing coverage). The effects of importing the disease from developing countries through immigration and of the AIDS epidemic are likely to negatively affect the trend of tuberculosis incidence in the future.

A simple, easy to use, kinetic model allowing the simulation of the main epidemiological parameters of tuberculosis and of the financial costs associated with the implementation of different anti-tuberculous policies, has been developed and described. The model, which has been denominated "ESKIMO" (Epidemiological Simulation Kinetic Model) can be utilized on a personal computer and requires, for its use, the knowledge of a series of easily available census data relative to a given country or geographical area, an essential epidemiological profile of the disease in the same area and data which characterize one or more antituberculous treatments in therapeutic and financial terms. The rationale of the model, which is a multicompartemental system, derive from an analysis of the relationships (transfer rates) between sub-populations of individuals in relation to tuberculosis either when the dynamic state of the system is governed by "natural forces" (no treatment) or when an external action is applied to it with an aim to alter its internal pathways in a favourable sense (vaccination, long-term hospitalization, chemotherapy). The model is based on the assumption that the main objective of any antituberculous program is the reduction in size of the subpopulation of patients who can infect other individuals and therefore perpetuate the disease. Validation and projection tests carried out through Eskimo seem to indicate that concentrating the analysis on the effect of various treatments on this group of patients simplifies the calculations while the relative precision of the estimates of other parameters is very satisfactory. The results of several simulations substantiate and quantify the opinions expressed by several experts in the past that the policy of applying cheap regimens of low efficacy to a relatively small fraction of the patients' population, as frequently done in developing countries, not only does not alter the trend of the disease but produces essentially negative results (increase in the number of new cases and in the frequency of resistant M. tuberculosis). Treatment with highly effective regimens of the same number of patients as those treated now (constant coverage) and therefore without the extra costs resulting from the improvement of the available sanitary infrastructures, produces much better results in clinical terms and overall saving of financial resources.

A clinical trial was performed to evaluate the efficacy of ciprofloxacin by iv administration in the treatment of respiratory infections. Twenty-two in-patients affected with acute lower respiratory tract infections, mainly infectious exacerbations of chronic obstructive lung disease (COLD), were treated with ciprofloxacin at the daily dosage of 400 mg iv, in two administrations. Overall clinical results were satisfactory (15 patients cured, 7 patients improved). Concerning bacteriological results, pathogen eradication was achieved in 83.3% of cases. Tolerability was good: no adverse events were observed.

Human Tumor Necrosis Factor-alpha (TNF-alpha) is a multifaceted cytokine mainly produced by activated monocytes or macrophages. Several recent studies have shown that TNF-alpha can exert a variety of in vitro and in vivo effects including: modulation of normal and malignant haemopoiesis, antineoplastic activity, activation of neutrophils, induction of IL-1 production, hyperpyrexia and induction of cachexia. Furthermore this cytokine is thought to play an important role in the pathogenesis of septic shock. The principal biochemical characteristics and biological activities of this cytokine will be here summarized.

The normal intestinal flora is an important defence against various infectious agents. It also allows important metabolic stages in the host. The Authors studied the ability of Enterococcus faecium SF 68 to protect the mice (Swiss strain) from infection by Salmonella typhi and its role when used with penicillin in infection by Staphylococcus aureus. Our results showed that SF 68, determined a good protection against infection. Moreover the association E. faecium SF 68-antibiotic lowers the mortality rate in the infected mice compared with the control group.

Recent technological developments have led in the the last years to the isolation and characterization of a group of polypeptides, generally termed cytokines, which are produced by cells of the immune system, and by other cell types; these peptides regulate the immune response and the inflammatory reaction, and, in general, cellular growth and differentiation. Because of the availability of large quantities of these cytokines, produced with recombinant DNA techniques, their use in therapy is now possible; promising results have been obtained in some diseases.

We report three cases of cryptococcal meningitis in patients with AIDS observed in our Institution. In addition, we discuss antifungal treatment during and after the acute phase of the disease and the use of fluconazole as a prophylactic treatment of disease relapse.

The combination of sulbactam (S) plus ampicillin (A) extends the activity of ampicillin (Amp) against beta-lactamase producing strains. This combination is therefore useful in many clinical situations including LRTI. A clinical trial was carried out to evaluate the clinical and bacteriological efficacy of S-Amp in LRTI in comparison with Amp alone. Concerning clinical outcome the results were satisfactory in 83.3% of cases for S-Amp group and 82.3% of cases for Amp group. Pathogen eradication was achieved in 87.5% and 70.5% of cases respectively for the S-Amp and Amp group.