Showing papers by "Robert C. Moellering published in 1976"
TL;DR: A host of new semisynthetic penicillins, some differing considerably both in antibacterial spectrums and in pharmacologic properties from the prototype (penicillin G), were introduced in the early 1990s.
Abstract: A host of new semisynthetic penicillins, some differing considerably both in antibacterial spectrums and in pharmacologic properties from the prototype (penicillin G), were introduced in the early ...
118 citations
TL;DR: The studies indicate that the therapy of severe infections in children with major burns often requires administration of gentamicin at higher doses and more frequent intervals than usually employed.
Abstract: During the treatment of Gram-negative bacillary infections in severely burned children, it was noted that administration of standard dosages of gentamicin commonly produced inadequately low serum concentrations of the antibiotic. Pharmakokinetic studies demonstrated that mean peak serum gentamicin levels were significantly lower in 18 burned children as compared with peak serum levels in five unburned children. Furthermore, inadequately low peak serum levels (less than 3.0 mug/ml) were observed in 15 of 18 burned children and in only one unburned child. Clearance studies in two children suggested that the increased requirement for gentamicin can result from either loss of the antibiotic across burn wounds or increased urinary excretion. These studies indicate that the therapy of severe infections in children with major burns often requires administration of gentamicin at higher doses and more frequent intervals than usually employed.
39 citations
TL;DR: It is suggested that tobramycin may be effective for treatment of some, but not all, infections caused by gentamicin-resistant bacteria.
Abstract: A computerized system for testing and surveillance of bacterial susceptibility to antibiotics was used in monitoring the emergence of gentamicin-resistant strains of aerobic and facultative gram-negative bacilli at Massachusetts General Hospital since the release of gentamicin for clinical use in 1971. During the period studied, there was a significant increase in the prevalence of gentamicin-resistant bacteria, particularly among Pseudomonas, Acinetobacter (Herellea), and Proteus and, more recently, among Enterobacter and Klebsiella. Most gentamicin-resistant strains of Pseudomonas aeruginosa and Acinetobacter calcoaceticus var. anitratum (Herellea varginicola) retained susceptibility to tobramycin. Of the other gentamicin-resistant organisms, most were also resistant to tobramycin. Twelve patients with infections caused by gentamicin-resistant organisms were treated with tobramycin. All 12 patients were seriously ill, and all but one had failed to respond to previous therapy with gentamicin. Nine patients responded favorably to tobramycin, and six were cured. P. aeruginosa and A. calcoaceticus var. anitratum were most frequently the infecting organisms in these patients. Patients received tobramycin for three to 42 days; no significant drug-related toxicity was noted. These results emphasize the increasing clinical importance of gentamicin-resistant bacteria and suggest that tobramycin may be effective for treatment of some, but not all, infections caused by gentamicin-resistant bacteria.
26 citations
TL;DR: A study of all groups L-T streptococci isolated at the Massachusetts General Hospital during a 10-year period was to ascertain the clinical significance of the less frequently occurring serological groups of strePTococci.
Abstract: due to group O streptococci represent the first cases described with endocarditis caused by this group of organisms. Virtually all of the isolates of groups L, M, N, and O streptococci were susceptible to penicillin. Seventy-four percent of the isolates were judged not responsible for clinical disease. The importance of avoiding inappropriate therapy makes it necessary to realize that these organisms are potential "contaminants" of cultures of blood and cerebrospinal fluid. Increased use of Lancefield serological grouping
21 citations
TL;DR: The majority of cases of infective endocarditis still occur in the setting of underlying rheumatic or congenital heart disease, although the number of cases currently falling into this category are much less than the 80% to 90% of cases seen in earlier years.
Abstract: IN CONSIDERING the patient with possible infective endocarditis, the medical history and physical examination are of paramount importance, for it is the clinical presentation that usually provides the initial clues to the diagnosis. The majority of cases of infective endocarditis still occur in the setting of underlying rheumatic or congenital heart disease, although the 40% to 60% of cases currently falling into this category are much less than the 80% to 90% of cases seen in earlier years. 1,2 A number of other lesions including calcific aortic stenosis and other forms of degenerative heart disease, idiopathic hypertrophic subaortic stenosis (asymmetrical septal hypertrophy), and mitral valve prolapse ("click-murmur" syndrome) may serve as the substrate for infective endocarditis. In recent years, increasing numbers of cases are found superimposed on prosthetic heart valves. Even normal heart valves can become infected, as in acute bacterial endocarditis due to Staphylococcus aureus . Fever is present in
18 citations
TL;DR: It is urged that all streptococci isolated from patients with serious infections be grouped serologically and be tested for antibiotic susceptibilities, especially if therapy with antibiotics other than penicillin is to be considered.
Abstract: We have recently observed four patients with bacteremic infections due to group A streptococci that were highly resistant to clindamycin and only moderately susceptible to erythromycin. Two of the infections developed while the patients were receiving clindamycin. The organisms were not β-hemolytic under standard conditions nor were they M or T typable. We urge that all streptococci isolated from patients with serious infections be grouped serologically and be tested for antibiotic susceptibilities, especially if therapy with antibiotics other than penicillin is to be considered. ( JAMA 236:263-265, 1976)
13 citations
TL;DR: Speciation of the organisms by a series of biochemical and physiologic tests suggested that the differences in initial FA reactivity were species-related and S. faecalis strains were the most FA-reactive and most sensitive to lysozyme.
Abstract: Damage to the cell wall by growth in the presence of penicillin or by treatment with lysozyme enhanced the immunofluorescent (fluorescent antibody, FA) reactivity of group D streptococci. The optimum concentration and time of treatment with lysozyme varied inversely with the initial FA reactivity of the strain. Speciation of the organisms by a series of biochemical and physiologic tests suggested that the differences in initial FA reactivity were species-related. Thus, S. faecalis strains were the most FA-reactive and most sensitive to lysozyme. S. faecium strains were less FA-reactive and lysozyme-sensitive. S. bovis strains proved to be least FA-sensitive and were most resistant to lysozyme. Treatment with lysozyme was also effective in preparing extracts of group D antigen from all three species for Lancefield grouping by the precipitin test. The lysozyme extracts, moreover, produced much stronger reactions than those made from comparable volumes of cells by the methods of Lancefield or of Rantz and Randall.
4 citations
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TL;DR: A 56-year-old woman was admitted to the hospital because of hypotension, and a diagnosis of chronic lymphocytic leukemia was made, and chlorambucil and allopurinol were instituted.
Abstract: Presentation of Case A 56-year-old woman was admitted to the hospital because of hypotension. She was well until three and half years earlier, when hypertension was found and was treated with hydrochlorothiazide. Twenty-six months before admission a diagnosis of chronic lymphocytic leukemia was made, and chlorambucil and allopurinol were instituted. During the six weeks before admission she received chlorambucil in a dose of 2 mg daily; the white-cell count ranged between 8000 and 11,000, and the platelets appeared adequate on stained specimens of the blood film. One week before entry, during June, she began to have pain in the left . . .
3 citations