[Lower urinary tract infections: bacterial epidemiology and recommendations].

Lower urinary tract infection remains frequent particularly in women, despite improvement in therapeutic means. It seems likely to revisit bacterial epidemiology and therapeutic available strategies. To analyze elements in presence i.

Pharmacodynamics of antibiotics in the respiratory tree.

For an antibiotic to be active in vivo, the concept of high tissue concentrations at infected sites has been popular for a long time, but has recently been criticised. The measurement of antibiotic tissue levels in humans is restricted by ethical issues, the cost of investigations and doubtful clinical significance. In the respiratory tree (RT), antibiotic concentrations have been studied.

[Pharmacologic innovations, the fluoroquinolone model].

Objectives: Like all the disciplines involved in infectious diseases and antibiotic therapy, pharmacokinetics and pharmacodynamics (PK/PD) of antibiotics have evolved significantly. They include new investigation procedures like in vitro models and new animal models. There is a current trend towards better methods, newer definitions and improved quality of research in this particular field.

[Latest news on fluoroquinolones].

THE AIMS OF NEW FLUOROQUINOLONES: Are to widen the antimicrobial spectrum and eventually reach anaerobic bacteria, to increase the activity on resistant Gram positive bacteria and to enhance the affinity of the molecule for the target enzymes of the bacteria THE EXPECTATIONS WITH THE NEW QUINOLONES: Globally, the tests conducted show far superior activity than that of the agents used for comparison. CONCERNING THE OLDER FLUOROQUINOLONES: Despite the threat of emergence of resistance in pneumococci, questions are raised on the clinical correspondence of the microbiological data obtained, notably with the rates of therapeutic failure, observed in patients exhibiting strains with supposedly high MICs.

Controlling acute bacterial maxillary sinusitis.

In acute maxillary sinusitis, after an initial viral episode, bacterial infection can be demonstrated using specific investigations and bacterial isolation. In the vast majority of cases, however, the diagnosis is presumptive. Symptomatic treatments tend to reduce pain and inflammation for easier pus drainage.

Clinical role of protein binding of quinolones.

Protein binding of antibacterials in plasma and tissues has long been considered a component of their pharmacokinetic parameters, playing a potential role in distribution, excretion and therapeutic effectiveness. Since the beginning of the 'antibacterial era', this factor has been extensively analysed for all antibacterial classes, showing that wide variations of the degree of protein binding occur even in the same antibacterial class, as with beta-lactams. As the understanding of protein binding grew, the complexity of the binding system was increasingly perceived and its dynamic character described.

Guidelines on antimicrobial chemotherapy for prevention and treatment of infections in the intensive care unit.

Severe infections (SIs) in Intensive Care Units (ICUs) constitute difficult therapeutic problems confronting clinicians who deal with severely ill patients. Some SIs are opportunistic infections acquired either in the community or in hospitals, particularly in immunodepressed patients. The great majority of ICU infections are of nosocomial origin.

[Blood culture update].

Background: Blood culture is one of the most important bacteriological examinations with important clinical and therapeutic consequences. Blood cultures should be ordered in all patients with signs suggesting septicemia, endocarditis or severe infection (pneumococcal pneumonia, bacterial meningitis with bloodstream dissemination). Blood culture methods have evolved considerably over the last twenty years.

[Epidemiology and management of suspected pneumonia in nursing home residents].

Objective: We conducted a descriptive epidemiology study to examine the conditions of management of infectious lung disease in institutionalized elderly populations (population profile, diagnostic and therapeutic modalities) and to analyze the general and mental consequences in terms of independence (impact of the infectious event on the subject's life style).

Patients And Methods: A pragmatic survey was conducted by a multicentric observatory composed of 573 general practitioners, practicing in nursing homes. The series included 1790 patients aged over 70 years and residing in nursing homes who developed infectious lung disease over a 10-month period.

The Increasing Role of Acinetobacter Species As Nosocomial Pathogens.

Among gram-negative organisms playing a significant role in nosocomial infections, Acinetobacter species have attracted increasing attention in intensive care units during the past two decades. Acinetobacter species are implicated in a wide spectrum of infections (eg, bacteremia, nosocomial pneumonia, urinary tract infections, secondary meningitis, superinfections in burn patients). One of the most striking features of Acinetobacter species is their extraordinary ability to develop multiple resistance mechanisms against major antibiotic classes.

The suppository form of antibiotic administration: pharmacokinetics and clinical application.

The rectal route of antibiotic administration might be used effectively when other routes of administration are inadequate or unsuitable. With the use of various adjuvants, the rectal route can provide satisfactory pharmacokinetics and acceptable local tolerance. Experiments in animals have demonstrated the influence of the pharmaceutical formulation of suppositories on the rectal absorption and systemic distribution of beta-lactams and aminoglycosides.

[West Nile virus (WNV) encephalitis].

Unlabelled: A DISEASE ON THE COME BACK: West Nile encephalitis has been known since the thirties. It generally occurs in Africa and Western Asia, rarely in Europe. The disease has disappeared from France since 1960, but has reappeared in the United States and in Israel.

[Resistance and new antibiotic strategies. Consequences of the use of antibiotics: how to preserve they efficacy].

FACTORS CONTRIBUTING TO RESISTANCE: Several factors contribute to the spread of resistance (international travel, grouping together severely ill patients, etc.) and others contribute to the emergence of resistance (e.g.

[Resistance and new antibiotic strategies. The other new molecules].

ANTI-PNEUMOCOCCAL DRUGS: New fluoroquinolones with different targets than earlier compounds have been found to be active in certain cases of respiratory tract pneumococcal infections. Moxifloxacin, levofloxacin and gatifloxacin have been particularly effective. These new antibiotics can be classed in a new category of "respiratory quinolones".

[Resistance and new antibiotic strategies. New antistaphylococcal antibiotics].

INJECTABLE SPECTROGRAMIN: Combination regimens using quinupristin/dafopristin with either gentamicin or vancomycin have powerful bactericidal activities (even against quinupristin-resistant strains) against methicillin-resistant Staphylococcus aureus (MRSA) in a model of experimental endocarditis in the rabbit. In clinical trials, quinupristin/dalfopristin is becoming a therapeutic alternative to consider after failure of conventional antistaphylococcal treatments. NEW GENERATION CEPHALOSPORINS: These new cephalosporins, particularly C-3 pyridinium-thiomethyl-cephalosporins, new (3-dithiocarbamoyl) cephalosporins, and a series of new compounds with high affinity for MRSA PLP2a, are particularly active against MRSA and are unaffected by beta-lactamases.

Treatment and prevention of antibiotic associated diarrhea.

Mild or severe episodes of antibiotic-associated diarrhea (AAD) are common side effects of antibiotic therapy. The incidence of AAD differs with the antibiotic and varies from 5 to 25%. The major form of intestinal disorders is the pseudomembranous colitis associated with Clostridium difficile which occurs in 10-20% of all AAD.

[ICAA 1999: news in antibiotic therapy].

NEW DERIVATIVES OF OLDER COMPOUNDS: Beta-lactamine derivatives include ne penems and carbapenems as well as beta-lactamase inhibitors and a few cephalosporins. Non-fluoroquinolones without a fluoride atom on position 6 have an antibacterial activity at least equivalent to the most active fluorated products available, suggesting that the contribution of the fluroide atom actually is of limited impact in fluoroquinolones. The clinical importance of these new derivatives remains to be documented.