Chemioterapia : international journal of the Mediterranean Society of Chemotherapy最新文献

The possible enhancement effect of acyclovir or its prodrug descyclovir in combination with human lymphoblastoid interferon (Wellferon) was studied in three trials with a total of 146 patients with chronic hepatitis B; a pilot study (Study 1; n = 12), two randomized controlled studies, one with a combination of descyclovir and interferon (Study 2; n = 36) and the other using acyclovir and interferon (Study 3; n = 98). The results from Study 1 and 2 showed that combination therapy with interferon and acyclovir or descyclovir (n = 25) was associated with a 40% HBe+ seroconversion rate, compared to 30% with interferon treatment alone (n = 10), 18% with acyclovir alone (n = 11) and 0% with no treatment (n = 18). Preliminary results from Study 3 on rate of HBe-seroconversion are similar to previous studies. Antiviral therapy with interferon and acyclovir or its prodrug, have resulted in significantly enhanced HBe seroconversion. The intravenous acyclovir component of combination therapy is however cumbersome and research should be directed towards finding an oral anti-hepatitis drug.

Several steps in the replicative cycle of human immunodeficiency virus (HIV) could be envisaged as targets for anti-AIDS drugs. The anionic compound PMEA [9-(2-phosphonyl-methoxyethyl)adenine], the 2'3'-dideoxynucleoside analogues D4T (2',3-deidehydro-2',3'-dideoxythymidine), AzddUrd 3'-azido-2',3'-dideoxyuridine), FddUrd (3'-fluoro-2',3-dideoxyuridine), AzddDAPR (3'-azido-2',3'-dideoxy-2,6' diaminopurine riboside) and the sulfated polysaccharides dextran sulfate and pentosan polysulfate are among the most promising candidate anit-AIDS drugs which have been recently described. They are targeted at either virus-cell binding (dextran sulfate, pentosan polysulfate) or virus-associated reverse transcriptase (PMEA, D4T, AzddUrd, FddUrd, AzddDAPR).

The Authors report microbiological data on the inhibitory activity of cephalothin, cefamandole, FCE 22101, gentamicin, netilmicin, amikacin, rifampicin, clindamycin, josamycin, ofloxacin, ciprofloxacin, vancomycin and teicoplanin against 165 clinically isolated Staphylococcus aureus strains. 34 of the study strains, i.e. 20.6%, were methicillin- and oxacillin-resistant. The activity of the tested drugs was good; the presence of nosocomial strains resistant to rifampicin (12.13%), clindamycin (13.94%), josamycin (18.2%), ofloxacin (4.85%), ciprofloxacin (12.7%), gentamicin (27.3%), amikacin (9.7%), netilmicin (7.9%) was noted. The Authors emphasize the good inhibitory activity of tested beta-lactam drugs against methicillin-sensitive Staphylococci, but also the limits of these drugs against methicillin-resistant strains. The activity of vancomycin and teicoplanin on all study strains was very good.

Ciprofloxacin is a broad-spectrum antibiotic orally active against both gram-positive and gram-negative bacteria. Recent literature indicates that orally administered activated charcoal can alter the bioavailability of many drugs and in vitro studies have demonstrated an interaction with ciprofloxacin. To evaluate in vivo the effects of activated charcoal on ciprofloxacin pharmacokinetics, six healthy volunteers received, according to a cross-over design, either ciprofloxacin 500 mg alone or concomitantly 1 g activated charcoal. The coadministration of the latter drug did not influence any of the considered pharmacokinetic parameters. Activated charcoal at a clinically effective dose, therapeutically used in gaseousness, does not alter ciprofloxacin pharmacokinetics.

It was previously thought that two distinct types of chronic hepatitis B virus (HBV) infection existed. However recent evidence suggests that these are in fact phases in a continuous spectrum which evolves with time. Immediately after infection there is active viral replication. In patients infected in adult life, particularly in Europe and the USA, this is associated with varying degrees of liver damage. In those infected at birth, particularly in the Far East, there is initially much less inflammation with normal liver function. In succeeding years, viral replication decreases and liver damage increases with more deranged liver function test results. Eventually viral replication ceases and liver inflammation decreases, resulting in seroconversion with a loss of HBeAg and appearance of anti-HBe. Unfortunately, cirrhosis has already developed in some adults, with the increased risk of the later development of primary hepatocellular carcinoma. It is likely that there is a favourable window during the natural history of the infection when interferon is effective, probably in the few years immediately before spontaneous seroconversion.

The aim of this study was to compare the effects of the prophylactic use of cefamandole versus oxacillin plus gentamicin on hemostasis in patients undergoing hip replacement with heparin prophylaxis. Twenty-four patients with a normal hemostatic profile were randomly allocated to receive either cefamandole or oxacillin plus gentamicin. All the patients received calcium heparin. Platelet count, bleeding time, prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin clotting time (TCT), fibrinogen and serum FDP were assessed before treatment and every day of antibiotic administration. Surgical bleeding was assessed using a four-grade score system. Platelet count, bleeding time, fibrinogen and serum FDP did not show any change with both treatments. PT, aPTT and TCT showed a similar and mild prolongation in the two groups of patients. No difference in the surgical bleeding was observed between the two groups. We conclude that a short-term prophylaxis with cefamandole is a safe regimen in patients undergoing hip replacement with heparin prophylaxis.

In reporting on the activity of cephalothin, cefamandole, FCE 22101, gentamicin, netilmicin, amikacin, rifampicin, clindamycin, josamycin, ofloxacin, ciprofloxacin, vancomycin and teicoplanin on 72 Staphylococcus epidermidis strains clinically isolated in the hospital, the Authors observed a high percentage of methicillin-resistance (68.05%) as well as resistance to other important drugs such as gentamicin (72.22%), rifampicin (27.7%), clindamycin (36.1%), and josamycin (40.27%). They also recorded good inhibitory activity of the studied beta-lactam drugs. However, this activity was not confirmed against methicillin-resistant strains when the test was performed under particular technical conditions (hypertonic medium, incubation at 30 degrees C, inoculum = 10(6)). The Authors also emphasize the poor bactericidal activity against these strains. The activity of quinolones was good; the activity of vancomycin and teicoplanin was very good on all strains studied.

Non A, non B (NANB) hepatitis is caused by at least three, as yet unidentified, viruses and can occur as a result of blood transfusions, the use of blood products, covert or overt percutaneous exposure and epidemic waterborne outbreaks of infection. The three types of viruses are characterised by their incubation times; a short time of 2-4 weeks, a longer time of 6-12 weeks and a intermediate period for the waterborne NANB hepatitis virus. Acute NANB hepatitis is milder than HBV hepatitis with lower peak transaminase levels. However, some develop into fulminant hepatitis with a lower survival rate of 0.13%. Ten to 100% of acute patients progress to chronic NANB hepatitis. It was found that alpha-lymphoblastoid interferon at levels of 3-5 megaunits (MU) thrice weekly returned transaminase levels to normal within 6-8 weeks. Approximately 80% had normal levels by the eighth week of treatment and this was maintained on 2.5-3 MU thrice weekly; a well tolerated dose. Long term, low-dose therapy is needed to maintain remission.

The immunomodulating properties of antimicrobial drugs may have important implications in prescriptive practice. This is particularly so for patients whose immune system has been compromised. In this study, tetracycline, cephalothin, rifampicin, polymyxin B and nitrofurantoin reduced mitogen responsiveness of both B and T lymphocytes of mouse spleen cells and human peripheral blood lymphocytes in vitro in a dose-dependent fashion. Ampicillin, chloramphenicol, gentamicin, streptomycin and erythromycin had no effect. In the in vivo study none of the antibiotics affected mouse spleen cell transformation in response to mitogen. The addition of interleukin-2 (IL-2) did not prevent the effect of the antibiotics tested on human lymphocytes in vitro. Cephalothin, chloramphenicol and gentamicin decreased IL-2 production by mouse spleen cells in vitro.