High blood pressure. Causes, symptoms, treatments

Assessment of risk area during coronary occlusion and infarct size after reperfusion with myocardial contrast echocardiography using left and right atrial injections of contrast.


Two controlled United States trials compared the safety and efficacy of cefpodoxime proxetil (100mg twice daily) with either cefaclor (250mg 3 times daily) or amoxicillin (250mg 3 times daily) in patients with uncomplicated urinary tract infections. Treatment duration was 7 days. 307 of 762 patients treated with cefpodoxime proxetil, 99 of 190 treated with cefaclor, and 57 of 185 treated with amoxicillin were evaluable for efficacy. 311, 99 and 59 pathogens were isolated from cefpodoxime proxetil, cefaclor and amoxicillin patients, respectively, the most common pathogens being Escherichia coli, Klebsiella spp., Proteus mirabilis, and Staphylococcus saprophyticus. Bacteriological cure rates were 80% (247/307), 82% (81/99) and 70% (40/57) for cefpodoxime proxetil, cefaclor and amoxicillin, respectively. Respective clinical cure rates were 79% (242/307), 79% (78/99) and 72% (41/57). Cefpodoxime proxetil was well tolerated, and there was no significant difference between the groups in the overall incidence of adverse experiences. Thus, cefpodoxime proxetil is efficacious and safe in the treatment of patients with uncomplicated urinary tract infections and compares favourably with cefaclor and amoxicillin.

As the post-marketing surveillance of cefpodoxime proxetil (Banan), MICs of cefpodoxime (CPDX, an active form of Banan) against 1090 clinical isolates of 22 species from 15 medical institutions all over Japan from June 2000 to March 2001 were measured using the broth microdilution method approved by the Japanese Society of Chemotherapy and compared with those of oral cephem antibacterials, cefaclor, cefdinir, cefditoren, and cefcapene. In this study, remarkable change in the activity of CPDX was observed in Streptococcus pneumoniae and Haemophilus influenzae compared with the susceptibility in the studies before Banan was launched. This cause is considered to be the increase in the incidence of the following resistant strains: penicillin-intermediate S. pneumoniae (47.3%), penicillin-resistant S. pneumoniae (PRSP, 15.1%), and beta-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae (24.0%), which were scarcely isolated in 1989 when Banan was launched. Other tested drugs also exhibited low activity against these resistant strains. However, CPDX showed comparatively good activity with MIC90 of 2 micrograms/mL against PRSP. Against methicillin-susceptible Staphylococcus spp., Streptococcus pyogenes, Streptococcus agalactiae, and Moraxella catarrhalis, CPDX also showed comparatively good activity with MIC90 of < or = 4 micrograms/mL, which was almost equal to that in the studies before its marketing. Against quinolones-resistant Neisseria gonorrhoeae, CPDX showed excellent activity with MIC90 of 0.5 microgram/mL. Against members of the family Enterobacteriaceae except for Citrobacter freundii, Enterobacter spp., Proteus vulgaris, and Morganella morganii, CPDX showed good activity. However, in Escherichia coli, Klebsiella spp. Proteus spp., and Providencia spp., there are some high-resistant strains to all tested drugs including CPDX. Against Peptostreptococcus spp., MIC90 of CPDX was 8 micrograms/mL and its MIC range was widely distributed from 0.03 to 32 micrograms/mL, which were similar to those in the studies before its marketing. In this study, CPDX showed the decrease in the activity against several species as did other drugs tested, but against most of species tested, CPDX maintained good activity. Furthermore, it is necessary to pay much attention to the trend of resistant strains.

Forty-four healthy volunteers were given either amoxycillin (ten subjects), cefpodoxime proxetil (ten subjects), ceftibuten (14 subjects) or cefuroxime axetil (ten subjects) orally for 7-10 days, in order to study the ecological effects on the intestinal microflora. In all three groups receiving oral cephalosporins there was a significant increase in beta-lactamase activity during administration (P < 0.05). There was also an inverse correlation between enzyme activity in faeces during administration compared with the concentration of drug in the intestines and the level of ecological disturbance in the normal intestinal microflora. In volunteers given amoxycillin, only small alterations in the faecal microflora were observed although overgrowth by new amoxycillin resistant enterobacteria occurred in all volunteers. There was an overgrowth of enterococci and yeasts during treatment with cefpodoxime proxetil, ceftibuten or cefuroxime axetil, whereas the numbers of enterobacteria were reduced. Colonization with resistant enterobacteria did not occur, but 14 of 34 subjects receiving oral cephalosporins were colonized by Clostridium difficile. Side-effects were mild and not associated with the ecological alterations in the intestinal microflora.

In the cefpodoxime study group, the average time receiving intravenous and oral antibiotics was 9.1 days at a total cost of $3040.26 for the 20 patients. In the control group, the average time receiving intravenous and oral antibiotics was 11.9 days at a total cost of $3961.26. A savings of $46.05 per patient was achieved. Patients receiving step-down therapy averaged 1 fewer day of hospitalization.