Ten patients with bacteremia due to methicillin-resistant Staphylococcus aureus were treated with vancomycin. These patients were compared with matched controls, nine bacteremic patients with methicillin-sensitive S. aureus, and one patient with penicillin-sensitive S. aureus. Controls were treated with a penicillin. There were no significant differences in time to defervescence, metastatic infections, relapse, mortality, need for surgical drainage, or duration of therapy. Fifteen of 19 episodes of serious methicillin-resistant S. aureus infection responded to vancomycin. Severe toxic effects included tinnitus, neutropenia, rash, and possible nephrotoxicity. Tolerance (a minimal bactericidal concentration to minimal inhibitory concentration ratio of at least 32), but not a minimal bactericidal concentration of at least 32 mg/L, correlated with therapeutic failure (respectively, p = 0.04 and p = 0.11, Fisher's exact test). Bacteremic infections due to methicillin-resistant and methicillin-sensitive S. aureus cause similar morbidity and mortality. Vancomycin is effective but potentially toxic therapy for most serious infections due to methicillin-resistant S. aureus. In-vitro tests may not predict therapeutic efficacy.
Minimal inhibitory and minimal bactericidal concentrations were determined for eighteen methicillin-resistant Staphylococcus aureus isolates, the majority also resistant to gentamicin, obtained from the blood of bacteraemic patients. Fifty per cent of organisms had a greater than four-fold difference in M.I.C. and M.B.C. for vancomycin, 83% for rifampicin, and 89% for fusidic acid. In-vitro effects of two-drug combinations of vancomycin, rifampicin, and fusidic acid demonstrated neither synergy nor antagonism when measured by a checkerboard dilution technique. The relevance of these findings to choice of therapy of serious infection due to methicillin-gentamicin resistant Staph. aureus is yet to be determined.
Zusammenfassung: Im Rahmen eines offenen klinischen Versuches wurden 50 Patientinnen mit Mturell‐mykologisch bestätigten Vaginalmykosen mit einer Einmaltherapie mit Gyno‐Pavogen® Vagiualtabletten (à 300 mg Isoconazolnitrat) behandelt. Der Partner wurde mit Gyno‐Travogen® Creme mitbehandelt. Eine Woche nach der Behandlung waren von 50 Patientinnen bei 43 (86 %) und nach vier Wochen von 37 Patientinnen bei 33 (89 %) die kulturell‐myko‐logischen Befunde negativ. Bei der ersten und der vier‐wöchigen Kontrolle waren 94% der Patientinnen klinisch erscheinungsfrei. Die subjektiven Beschwerden reduzierten sich dementsprechend.
Summary: 50 patients with culture‐proven vaginal mycosis were treated with a single dose treatment using Gyno‐Travogen® vaginal tablets (300 mg isoconazolnitrat/tabl.). The partners were treated with Gyno‐Travogen® cream. One week after treatment 43 (86 %) of 50 patients and after one month 33 (89%) of 37 patients were mycologically cured. At the first control one week after treatment and a second control after four weeks clinical improvement was noted in 94 per cent of the patients. The subjective symptoms had been reduced the same rate.
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