In the past five years three prospective randomized studies compared five different prophylactic antimicrobial regimens in major cardiovascular surgery. In 1980/81 a 4 d cefazolin (CFZ) prophylaxis (16 X 0.5 g) was compared with a 2 d cefuroxime (CFX) administration (4 X 1.5 g). Of the 566 patients who entered the study 281 received CFZ and 285 were given CFX. In 1982/83 a 2 d CFX prophylaxis (4 X 1.5 g) was compared with a two shot ceftriaxone (CRO) prophylaxis (2 g i.v., + 1 g 24 h later). Of the 512 patients enrolled 258 received CFX and 254 CRO. In 1984/85 a 1 d CFZ prophylaxis (4 X 0.5 g) was compared with a single shot prophylaxis of CRO (1 X 2 g). Of the 541 patients who entered the study 272 received CFZ and 269 CRO. All patients of age 16 y or older who were undergoing open heart surgery (n = 1384) and surgery of the major arteries (n = 235) were eligible for trial entry with the following exceptions: patients with preoperative infections, those who had received an antibiotic within 48 h of operation, and any with known allergies to cephalosporins or who had suffered an anaphylactic reaction to any penicillin. The patients were allocated to one of the two treatments by means of a randomized code, stratified for cardiac and major vascular operations. The first dosis was always given prior to surgery at the beginning of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
In a multicentre, open, randomised study, the efficacy and tolerability of intravenous meropenem (1 g every 8 h, infusion or bolus) was compared with that of intravenous imipenem/cilastatin (1 g every 8 h, infusion) in 232 hospitalised patients with moderate to severe intra-abdominal infections.At the end of therapy, a satisfactory clinical response (cure or improvement) was seen in 79/82 (96%) evaluable meropenem patients and 83/88 (94%) imipenem/ cilastatin patients; this was still seen at follow-up (57/63; 90% and 58/66; 88%, respectively). A satisfactory bacteriological response (elimination or presumed elimination) was seen in 69/82 (84%) meropenem patients and 71/88 (81%) imipenem/cilastatin patients at the end of therapy and in 52/62 (84%) and 55/70 (79%), respectively, at follow-up. There was a high level of clinical cure or improvement (95% for both treatment groups) in the 120 patients (60 in each group) who had polymicrobial infections.A similar incidence of adverse events was seen in each group: 45/116 patients in the meropenem group (72 events) and 42/116 patients in the imipenem/cilastatin group (65 events); the adverse event profiles were also similar, with injection site inflammation and elevated transaminases the most frequent in both groups. The results of this study indicate that monotherapy with meropenem was as effective and as well tolerated as the combination of imipenem/cilastatin in the treatment of moderate to severe intra-abdominal infections.
Between 1961 and 1974 a total of 29 patients have been treated for empyema after lung resection. Pneumonectomy for bronchus carcinoma had been previously performed in 19 patients, partial resection of the lung in ten. In the majority of cases a technical insufficiency was at last partially responsible for appearance of empyema. Differentiation between empyema after pneumonectomy and empyema in patients with residual lung parenchyma has proved to be of advantage. As to predisposing factors, treatment and prognosis of empyema in cases with residual parenchyma is comparable to regular pulmonary empyema. Empyema after pneumectomy however is different in treatment and prognosis. Irrigation of the infected thoracic cavity either by repeated punction and/or by continous through-drainage is helpful and improves the otherwise poor prognosis.
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