The effects of diclofenac, a nonsteroidal anti-inflammatory drug, on biliary excretion of ceftriaxone were evaluated in rabbits. In a previous study, we demonstrated that diclofenac increased the extravascular diffusion and antibacterial efficacy of ceftriaxone without any effect on serum protein binding and urinary excretion of this antibiotic. We perfected a surgical procedure that allowed the study of biliary secretion in conscious rabbits with a stable hemodynamic state. The kinetic study was carried out on the fourth day of treatment with ceftriaxone alone (30 mg/kg per day given intramuscularly; group 1) or combined with diclofenac (1.5 mg/kg per 12 h given intramuscularly; group 2). Cumulative biliary excretion of ceftriaxone over 6 h was significantly reduced in group 2 (5,291.6 + 2,017.5 ,ug in group 1 versus 1,379.1 + 567.1 ,ug in group 2). This phenomenon occurred without any change in biliary flow. Indocyanine green clearance (20 mg/kg) increased in animals treated with ceftriaxone alone compared with the saline-treated control group (55.04 ± 4.68 versus 33.29 + 7.52 ml/min per kg, respectively). Diclofenac alone caused a significant decrease in indocyanine green clearance compared with clearance in controls (25.05 ± 4.74 versus 33.29 + 7.52 ml/min per kg), and indocyanine green clearance appeared not significantly different from control values in animals receiving ceftriaxone plus diclofenac. These results suggest that (i) ceftriaxone could increase hepatic blood flow and (ii) reduction of the hepatic clearance of ceftriaxone by diclofenac may be due to hepatic hemodynamic variations involving diclofenac inhibition of prostaglandin synthesis, although an interaction of diclofenac with hepatic uptake of ceftriaxone cannot be ruled out.The use of nonsteroidal anti-inflammatory drugs in the therapy of infectious diseases remains a subject for debate. Recent studies argue for a beneficial effect of cyclooxygenase inhibitors on gross pathology and levels of prostaglandin E2 in Staphylococcus aureus-induced experimental osteomyelitis (17) without any significant effect on the mean counts of S. aureus. Khurana and Deddish (C. M. Khurana ad P. A. is , Pr:am Abstr. 26th Intersci. Conf. Antimicrob. Agents Chemother., abstr. no. 544, 1986) reported that the administration of ibuprofen in conjunction with oxacillin or clindamycin increased the effectiveness of the antibiotic against an oxacillin-tolerant strain of S. aureus in an experimental model of osteomyelitis. These results suggest that prostaglandins may be involved in the pathogenesis of bone infection and that inhibition of their secretion may prevent deleterious lesions and help antibiotic efficacy. In the same respect, Tuomanen et al. (21) studied the effect of diclofenac on the inflammatory response in cerebrospinal fluid during Streptococcus pneumoniae-induced experimental meningitis in rabbits. The ability of the pneumococcal cell wall to cause death and to generate leukocytosis and an abnormal cerebrospinal fluid chemistry was prevented by the in...
Recurrent genital herpes in immunocompromised patients may sometimes run a severe course spreading all over the perineum. Herpes simplex virus may develop resistance to acyclovir. A recurrent genital herpes simplex virus (HSV) infection complicating the treatment of Hodgkin's disease continued to spread in spite of acyclovir treatment via discontinuous infusion. Resolution of genital herpes was obtained with continuous infusion of acyclovir. Case ReportA 32-year-old woman had a history of recurrent genital herpes and received long-term treatment with oral acyclovir. Because of Hodgki.n's disease, chemotherapy and radiotherapy had been performed. A very low white blood cell and lymphocyte count was observed and the patient was consequently put on G-CSF (granuloeyte colony-stimulating factor). A disseminated eryptococcosis (fungemia, meningo-encephalitis, pneumonia) occurred and was treated with amphotericin B + 5 fluorocytosine, both intravenously, followed by fluconazole. Recurrent genital herpes appeared during the hospital stay, extending to a large placard over the perineum. The patient was then put on acyclovir IV 500 mg 1 h q.8 (i.e., 45 mg/kg/day). There was no improvement after 12 days of treatment. Therefore a continuous infusion of acyclovir was performed (2 g/day, 50 mg/kg/day) leading to recovery. The dosage of acyclovir was diluted to a total of 240 ml to be administered intravenously by a constant rate infusion.pump. The patient responded clinically within 6 days and by 14 days her lesions had healed, Unfortunately, we could neither carry out swabs from suspected lesions to isolate HSV, nor could we measure acyclovir levels in plasma.
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