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First and Second Generation Cephalosporins
Il>TFECTIONS AI'lD Al\JTIBIO'I'ICS
R.
M. FRENCH AND C.H. NIGHTINGALE, Division Infectious Diseases and ,..,,,n,rm,u•'\) Services, Hartford Hospital, Hartford, Connecticut QUINTIUANI,
Med. Clin. N. Amer., 66: 183-197 (Jan.) 1982 This is a general review article focusing attention almost entirely on the tissue penetration characteristics of the first and second generation cephalosporins, indicating the possible clinical relevance of this information. The article is a thorough and detailed review of the cellular pharmacokinetics of these often used compounds. W.J.C. 6 tables, 86 references
877
shorter 1R•1:>µ<1Lou.u.a of contributing factors. ch.en-i1s:tr and mechanism of actions, spectrum, pharmacokinetics and indications of the first and second line antituberculous drugs. In addition, tables are provided with recommended regimens for the treatment of active tuberculosis, indications for preventive therapy and recommended daily doses of antituberculous drugs. W.J.C. 5 tables, 52 references Chemotherapy of the Systemic My coses UTZ, School of Medicine, Georgetown University, Washington, D. C.
J.P.
Med. Clin. N. Amer., 66: 221-233 (Jan.) 1982 Urinary Tract Antiseptics MAYRER AND V. T. ANDRIOLE, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
A. R.
Med. Clin. N. Amer., 66: 199-208 (Jan.) 1982 N alidixic acid, oxolinic acid, nitrofurantoin and methenamine are known as urinary tract antiseptics because their pharmacokinetic fate is one of selective and bactericidal concentration in the urine. Each of these agents is discussed thoroughly with regard to specific advantages and disadvantages. All share a pharmacokinetic fate that makes them effective in treating acute, uncomplicated symptomatic bladder bacteriuria. Nitrofurantoin appears to be the most versatile because it is effective against upper tract infection, recurrent bacteriuria and as a long-term suppressive agent in children and pregnant patients with only a low incidence of the development of resistance. Methenamine, when used with proper understanding of its pharmacokinetic behavior, also is effective in female patients with uncomplicated recurrent bacteriuria, including those with multiple resistant pathogens, as well as a prophylactic agent in male patients with recurrent infection. There is little evidence that methenamine combined with mandelic or hippuric acid confers any advantage over the use of methenamine base alone. Nalidixic and oxolinic acid, in addition to effectiveness in treating uncomplicated acute lower urinary tract infections, may be effective in some patients with recurrent infections but requires careful sensitivity monitoring of pathogens for the rla,ua-"'''",,",.'..","'" of resistance. Finally, in a society whose economic pressures are such that it may not be cost-effective to use sulfamethoxazoletrimethoprim for tract prophylaxis-unless ~2 acute infections occur yearly-the use of these antiseptics may offer increasing financial advantages now and in the future.
W.J.C.
Successful chemotherapy of at least 1 fungal infection, sporotrichosis, antedates such therapy of any other infection. Since the early treatment with the iodide of potassium in 1903 there has been an improvement in the armamentarium of drugs for use against systemic mycoses. The author outlines the various agents currently available and their specific indications, dosage and side effects. This thorough review is highly recommended to individuals involved in the treatment of infections. Vv.J.C. 115 references Antiviral Drugs C. Lrn, Division Infectious Diseases, University School ol Medicine, Kansas Kansas
Kansas
Med. Clin. N. Amer., 66: 235-244 (Jan.) 1982 Viruses are obligatory intracellular parasites. They are subcellular and microscopic, with primitive structures consisting of a nucleic acid genome (either deoxyribonucleic or ribonucleic acid) and a protein coat. Viruses cannot multiply by growing in size and dividing like bacteria. They possess few or none of the biosynthetic enzymes. Replication of viruses requires an active participation of the host cell. When a virion enters a susceptible cell it sheds its protein coat and the viral nucleic acid comes into contact with the host cell machinery to direct the cell in synthesizing specific proteins necessary for viral reproduction. Since the replicative cycle of viruses is so intertwined with the metabolic functions of the mammalian cell it has been difficult to find chemotherapeutic agents that could interfere with the viral without toxicity to the host cells. to the aforementioned biologic characteristics of viruses antiviral drugs are agents with narrow spectrums. A diagnosis of viral infection on clinical alone is unreliable and etiology diagnosis laboratory means is timeconsuming and generally unavailable in most clinics and hos-
l table, 41 references This article is rather cursory and only focuses on a few agents that are relevant clinically and have been approved for clinical Anti.tuberculous Drugs use or trials in the United States. The agents include interferon, whose mode of action acts indirectly by binding to specific T. T. YOSHIKAWA AND N. K FUJITA, Division Geriatric Medicine, Veterans Administration Wadsworth Medical receptors in the cell surface and inducing the production of Center, Los Angeles, and Division of Infectious Diseases, cellular enzymes that inhibit the transplantation of viral mesHarbor-UCLA Medical Center, Torrance, and University of senger ribonucleic acid into protein synthesis, resulting in the blockage of a viral reproduction. Thus, since interferons do not California School of Medicine, Los Angeles, California exert a direct inhibitory effect on viral replication but induce Med. Clin. N. Amer., 66: 209-219 (Jan.) 1982 · an intracellular antiviral state in host cells, they are nonspecific Chemotherapy for tuberculosis has changed significantly in and effective against a wide range of viruses. They are, however, the last 10 years. Newer chemotherapeutic agents, improved species-specific in their range of antiviral activity. Thus, current pharmacologic knowledge, expanding therapeutic regimens and interferons are produced from human cells.
R.
M. FRENCH AND C.H. NIGHTINGALE, Division Infectious Diseases and ,..,,,n,rm,u•'\) Services, Hartford Hospital, Hartford, Connecticut QUINTIUANI,
Med. Clin. N. Amer., 66: 183-197 (Jan.) 1982 This is a general review article focusing attention almost entirely on the tissue penetration characteristics of the first and second generation cephalosporins, indicating the possible clinical relevance of this information. The article is a thorough and detailed review of the cellular pharmacokinetics of these often used compounds. W.J.C. 6 tables, 86 references
877
shorter 1R•1:>µ<1Lou.u.a of contributing factors. ch.en-i1s:tr and mechanism of actions, spectrum, pharmacokinetics and indications of the first and second line antituberculous drugs. In addition, tables are provided with recommended regimens for the treatment of active tuberculosis, indications for preventive therapy and recommended daily doses of antituberculous drugs. W.J.C. 5 tables, 52 references Chemotherapy of the Systemic My coses UTZ, School of Medicine, Georgetown University, Washington, D. C.
J.P.
Med. Clin. N. Amer., 66: 221-233 (Jan.) 1982 Urinary Tract Antiseptics MAYRER AND V. T. ANDRIOLE, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
A. R.
Med. Clin. N. Amer., 66: 199-208 (Jan.) 1982 N alidixic acid, oxolinic acid, nitrofurantoin and methenamine are known as urinary tract antiseptics because their pharmacokinetic fate is one of selective and bactericidal concentration in the urine. Each of these agents is discussed thoroughly with regard to specific advantages and disadvantages. All share a pharmacokinetic fate that makes them effective in treating acute, uncomplicated symptomatic bladder bacteriuria. Nitrofurantoin appears to be the most versatile because it is effective against upper tract infection, recurrent bacteriuria and as a long-term suppressive agent in children and pregnant patients with only a low incidence of the development of resistance. Methenamine, when used with proper understanding of its pharmacokinetic behavior, also is effective in female patients with uncomplicated recurrent bacteriuria, including those with multiple resistant pathogens, as well as a prophylactic agent in male patients with recurrent infection. There is little evidence that methenamine combined with mandelic or hippuric acid confers any advantage over the use of methenamine base alone. Nalidixic and oxolinic acid, in addition to effectiveness in treating uncomplicated acute lower urinary tract infections, may be effective in some patients with recurrent infections but requires careful sensitivity monitoring of pathogens for the rla,ua-"'''",,",.'..","'" of resistance. Finally, in a society whose economic pressures are such that it may not be cost-effective to use sulfamethoxazoletrimethoprim for tract prophylaxis-unless ~2 acute infections occur yearly-the use of these antiseptics may offer increasing financial advantages now and in the future.
W.J.C.
Successful chemotherapy of at least 1 fungal infection, sporotrichosis, antedates such therapy of any other infection. Since the early treatment with the iodide of potassium in 1903 there has been an improvement in the armamentarium of drugs for use against systemic mycoses. The author outlines the various agents currently available and their specific indications, dosage and side effects. This thorough review is highly recommended to individuals involved in the treatment of infections. Vv.J.C. 115 references Antiviral Drugs C. Lrn, Division Infectious Diseases, University School ol Medicine, Kansas Kansas
Kansas
Med. Clin. N. Amer., 66: 235-244 (Jan.) 1982 Viruses are obligatory intracellular parasites. They are subcellular and microscopic, with primitive structures consisting of a nucleic acid genome (either deoxyribonucleic or ribonucleic acid) and a protein coat. Viruses cannot multiply by growing in size and dividing like bacteria. They possess few or none of the biosynthetic enzymes. Replication of viruses requires an active participation of the host cell. When a virion enters a susceptible cell it sheds its protein coat and the viral nucleic acid comes into contact with the host cell machinery to direct the cell in synthesizing specific proteins necessary for viral reproduction. Since the replicative cycle of viruses is so intertwined with the metabolic functions of the mammalian cell it has been difficult to find chemotherapeutic agents that could interfere with the viral without toxicity to the host cells. to the aforementioned biologic characteristics of viruses antiviral drugs are agents with narrow spectrums. A diagnosis of viral infection on clinical alone is unreliable and etiology diagnosis laboratory means is timeconsuming and generally unavailable in most clinics and hos-
l table, 41 references This article is rather cursory and only focuses on a few agents that are relevant clinically and have been approved for clinical Anti.tuberculous Drugs use or trials in the United States. The agents include interferon, whose mode of action acts indirectly by binding to specific T. T. YOSHIKAWA AND N. K FUJITA, Division Geriatric Medicine, Veterans Administration Wadsworth Medical receptors in the cell surface and inducing the production of Center, Los Angeles, and Division of Infectious Diseases, cellular enzymes that inhibit the transplantation of viral mesHarbor-UCLA Medical Center, Torrance, and University of senger ribonucleic acid into protein synthesis, resulting in the blockage of a viral reproduction. Thus, since interferons do not California School of Medicine, Los Angeles, California exert a direct inhibitory effect on viral replication but induce Med. Clin. N. Amer., 66: 209-219 (Jan.) 1982 · an intracellular antiviral state in host cells, they are nonspecific Chemotherapy for tuberculosis has changed significantly in and effective against a wide range of viruses. They are, however, the last 10 years. Newer chemotherapeutic agents, improved species-specific in their range of antiviral activity. Thus, current pharmacologic knowledge, expanding therapeutic regimens and interferons are produced from human cells.