MedChemExpress PF-1355 Clinical efficacy of a continuous infusion of cefepime versus an intermittent regimen in

MedChemExpress PF-1355 Clinical efficacy of a continuous infusion of cefepime versus an intermittent regimen in critically ill adults patients with gram negative bacilli infection. Methods: The prospective cross-over study was carried out in 34 patients with severe pneumonia (n = 26) or bacteriemia (n = 8). There were randomized to receive Cefepim 4 g per day either as a continuous infusion (Group 1, n = 17) or intermittent administration 2 g x 2 (Group 2, n = 17) in combination with amikacin 15 mg/kg/day in the two groups. Patients were significantly comparable in terms of age, sex, initial infection disease, IGS II score and MIC of gram negative bacilli isolated. Clinical outcomes: mechanical ventilation, ICU stay durations and clinical recovery were assessed along with pharmacokinetic (24-hour AUIC, 12-hour AUIC) and pharmacodynamic (T > MIC and T > 5 MICs) in both groups and compared (chi-squared and Mann hitney U-tests). Results with P < 0.05 were considered significant. Results: Mechanical ventilation, clinical recovery (13 vs 11), bacteriologic eradication (12 vs 10) and duration of stay in ICU (35 vs 38 days) were better in Group 1 but did not significantly differ between the two group. Neither did 24-hour AUIC (569 vs 414) nor 12-hour AUIC (218 vs 202). However, T > MIC in Group 1 (23.8 ?0.2) was significantly higher (P < 0.05) than in Group 2 (20.4 ?3). T > 5 MICs in Group 1 (23.6 ?0.6) was also very significantly higher (P < 0.01) than in Group 2 (16.7 ?6). Conclusion: Clinical outcome was similar but our results indicate that continuous infusion likely provides a better steady bactericidal effect with concentration above MIC than intermittent administration, especially if there is a high risk of cephalosporinase as with Enterobacter spp. Further studies including more patients are necessary to confirm the interest of continuous infusion and to assess the possibility of reducing the daily dosage.PLeptospirosis and acute respiratory failure: report of 34 casesSRR Vieira, JS Brauner ICU from Hospital Cl icas de Porto Alegre (UFRGS)/Hospital NS Concei o, S Luis 1127, 501, CEP 90620-170, Porto Alegre, RS, Brazil Introduction: Leptospirosis is generally found in tropical regions but it can occur in temperate regions. It is caused by all kinds of leptospiras and it is, in general, a self limited disease. However, reports of important complications as acute respiratory failure (ARF), associated or not with other organic dysfunction had increased in the last PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20718396 years and had been associated with a high mortality rate [1]. Objective: The goal from this paper is to evaluate the clinical characteristics and the morbimortality of severe leptospirosis associated with ARF in two general ICU from two general hospitals. Methods: All cases with the diagnosis of leptospirosis, confirmed by blood macroagglutination test, associated with ARF and admitted from January 1990 to October 2000, in two general ICU from two general hospitals, were studied. There were analyzed the clinical and laboratory characteristics, the associated organic dysfunction and the mortality rate. Survivors were compared with non-survivors. The quantitative variables have been compared by unpaired t-test and the qualitative variables by a chi-squared test. The level of significance was P < 0.05. Results: We described 34 adults patients, 39 ?16 years, 28 men and 6 women. The most frequent clinical manifestation were dyspnea (n = 32), fever (n = 31), myalgias (n = 29), jaundice (n = 28), hemoptysis.