[Use of moxalactam in intensive care units: clinical and bacteriological results related to serum and bronchial concentrations ].
Twenty-patients (14 with mechanical ventilation) received moxalactam in an intensive care unit for pneumonia (3 cases), empyema (5 cases), bronchopneumonia (8 cases), bronchopneumonia with bacteremia (4 cases), 23 organism were isolated and 16 were hospital-acquired: Staphylococcus (3), Escherichia coli (1), Klebsiella-Enterobacter-Serratia (5), Proteus (3), Aeruginosa (2), Acinetobacter (2), These patients received moxalactam at the dosage of 500 mg/8H, 5 at 1 g/12H and 13 at 1 g/8H. Daily dosage ranged between 25 and 50 mg/kg; mode of administration was IM (16) or IV infusion pump (5) and mean duration of treatment was 12 days (range 6-21). Serum and bronchial secretion samples were assayed by the agar diffusion technique utilizing a susceptible strain of enterobacter cloacae (0.06 microgram/ml) as assay organism. At 1 h, mean serum concentrations were 31.5 micrograms/ml after 1 g IM every 12H, 54.9 micrograms/ml after 1 g IM every 8H and at 30 mn after the end of the infusion, serum concentrations were 54.2 micrograms/ml. At the same time, bronchial secretion concentrations were respectively 2.1 micrograms/ml, 5 micrograms/ml and 3.7 micrograms/ml. Clinical cures were obtained in 16 (80%) and bacteriological cures occurred in 14 (70%); of the 12 hospital - acquired infections patients, 8 experienced clinical cures (66%) and the emergence of the following organisms was observed during moxalactam treatment: Staphylococcus (1), Enterococcus (1), Pseudomonas aeruginosa (1), Acinetobacter (3), For the 20 patients, we noted 4 adverse effects: pruritic morbilliform eruption (1), thrombocytosis (1), eosinophilia (2), To avoid failures, the usefulness of routine combinations with amyglycosides is discussed for the cases of hospital - acquired infections.
D000328:Adult; D000368:Aged; D002511:Cephalosporins / Q000627:therapeutic use*; D002513:Cephamycins / Q000032:analysis / Q000097:blood / Q000627:therapeutic use*; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009070:Moxalactam; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D018805:Sepsis / Q000188:drug therapy; D013183:Sputum / Q000032:analysis
D002511:Cephalosporins; D002513:Cephamycins; D009070:Moxalactam
Emploi du moxalactam en réanimation. Résultats cliniques et bactériologiques rapportés aux concentrations sériques et bronchiques.