***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Ninety-four cases of pyelonephritis including 20 who had concurrent bacteremia were treated with cefam and ole alone or in combination with either gentamicin or tobramycin . Doses of cefam and ole ranged from 1 - -2 g by intermittent intravenous ( VI ) infusion every 4 to 8 h ; gentamicin and tobramycin doses ranged from 1 - -1.7 mg/kg every 8 h also by intermittent IV infusion . Duration of therapy ranged from 5 to 23 days ( mean 7.3 days ) . Both single and combination therapy successfully treated acute pyelonephritis and bacteremia in all patients . Seven strains of E. coli and one of Klebsiella pneumoniae responsible for initial infection were resistant to cephalothin but sensitive to cefam and ole .  Relapse with cefam and ole sensitive bacteria occurred in 27 % of patients receiving only cefam and ole and 8 % of those patients receiving combination therapy . Reinfection with cefam and ole resistant organisms , predominantly Pseudomonas aeruginosa occurred in five patients . One patient had an intrarenal abscess due to E. coli which was successfully treated with 23 days of cefam and ole . One patient died . However , death was due to acute pulmonary embolism , not infection . None of the patients receiving cefam and ole plus gentamicin or tobramycin experienced a significant decrease in creatinine clearance during or after therapy . Skin rash , mild thrombophlebitis at the IV site and transient elevation of alkaline phosphatase and SGOT were the only side effects noted To determine whether combination antibiotic therapy including a short course of an aminoglycoside was as effective and less toxic than a conventional long course of the combination for the empirical therapy of gram-negative bacteremia in patients with cancer and granulocytopenia , we conducted a r and omized multicenter trial comparing ceftazidime plus a short course ( three days ) of amikacin , ceftazidime plus a long course ( nine days ) of amikacin , and azlocillin plus a long course ( nine days ) of amikacin .  Single-organism gram-negative bacteremia occurred in 129 of 872 evaluable patients . Without a change in antibiotics , the response rates were 81 percent with ceftazidime and long-course amikacin , 48 percent with ceftazidime and short-course amikacin ( P = 0.002 ) , and 40 percent with azlocillin and long-course amikacin ( P less than 0.001 ) . Among patients with fewer than 100 granulocytes per cubic millimeter throughout therapy , the response rates were 6 percent with ceftazidime and short-course amikacin and 50 percent with ceftazidime and long-course amikacin ( P = 0.03 ) . Linear logistic-regression analysis showed that therapy with ceftazidime and long-course amikacin was the most favorable prognostic factor of the response to infection , whereas the presence of leukemia or shock was the least favorable . We conclude that ceftazidime should be given in combination with a conventional full course of an aminoglycoside ( amikacin ) when used for the empirical treatment of gram-negative bacteremia in cancer patients with granulocytopenia A total of 34 patients with intractable chronic respiratory tract infections were treated with isepamicin and /or piperacillin in different dosage regimens . A comparison of the bacteriological effect using a cross over method showed a reduction in the count of Pseudomonas aeruginosa in sputum in the group receiving once-a-day isepamicin combined with piperacillin , compared with the twice-a-day combined administration . A comparison of the clinical and bacteriological efficacy between the different regimen groups revealed no noticeable difference . The clinical effect of this regimen is comparable to the conventional regimen , but has the advantages of a safer dosage and ease of administration Two hundred and eighty-four febrile episodes in immunocompromised patients were treated with ceftriaxone alone or in combination with amikacin . In the ceftriaxone-treated group , 60 out of 143 febrile episodes were microbiologically documented , while in the group receiving the combination therapy , there were 32 out of 140 ( p = 0.0007 ) . Gram-positive microorganisms were more common than gram-negative ones , accounting for 59 of the 101 isolated bacteria . The ceftriaxone regimen appeared to have a response rate comparable to the combination regimen ( 73.91 vs. 78.88 % ) . Superinfections occurred under both regimens The authors wanted to verify if in clinical practice ( Intensive Care Unit patients ) , the association of azlocillin with an aminoglycoside offers substantial advantages compared to use of azlocillin alone . Their results show that azlocillin alone is potent enough to be used in the treatment of severe infections Introduction Combination antibiotic therapy for ventilator associated pneumonia ( VAP ) is often used to broaden the spectrum of activity of empirical treatment . The relevance of such synergy is commonly supposed but poorly supported . The aim of the present study was to compare the clinical outcome and the course of biological variables in patients treated for a VAP , using a monotherapy with a beta-lactam versus a combination therapy . Methods Patients with VAP were prospect ively r and omised to receive either cefepime alone or cefepime in association with amikacin or levofloxacin .  Clinical and inflammatory parameters were measured on the day of inclusion and thereafter . Results Seventy-four mechanically ventilated patients meeting clinical criteria for VAP were enrolled in the study . VAP was microbiologically confirmed in 59 patients ( 84 % ) . Patients were r and omised to receive cefepime ( C group , 20 patients ) , cefepime with amikacin ( C-A group , 19 patients ) or cefepime with levofloxacin ( C-L group , 20 patients ) . No significant difference was observed regarding the time course of temperature , leukocytosis or C-reactive protein level . There were no differences between length of stay in the intensive care unit after infection , nor in ventilator free days within 28 days after infection . No difference in mortality was observed . Conclusion Antibiotic combination using a fourth generation cephalosporin with either an aminoside or a fluoroquinolone is not associated with a clinical or biological benefit when compared to cephalosporin monotherapy against common susceptible pathogens causing VAP 93 patients were enrolled into a prospect i ve r and omised study to determine the efficacy and safety of netilmicin , cefotaxime or their combination in the treatment of sepsis caused by susceptible strains of Enterobacteriaceae or staphylococci . 83 patients were evaluable for safety , 74 for clinical efficacy and 63 for microbiological response including 36 patients ( 57 % ) with positive blood cultures . There were significantly more clinical failures with cefotaxime than with netilmicin even when urinary tract sepsis was excluded . Microbiological failures occurred more frequently in the cefotaxime arm and were associated with Klebsiella and Enterobacter spp . Four cefotaxime failures were subsequently successfully treated with netilmicin . More mixed infections were however enrolled by chance into the cefotaxime arm . The statistical difference between netilmicin and cefotaxime is not significant if mixed infections are excluded . There was no difference in efficacy between the netilmicin and combination groups although superinfection was seen in the latter group . The incidence of nephrotoxicity was greater in the netilmicin group but not significantly so . Only one minor case of ototoxicity was detected in the 41 patients receiving netilmicin who had serial audiograms . The results suggest that netilmicin is a more effective agent than cefotaxime for treating life-threatening infections with susceptible Enterobacteriaceae or staphylococci particularly with infections in non-urinary tract sites . If dosage of netilmicin is closely monitored by measuring serum concentrations , toxicity is minimal Meropenem is a new broad spectrum carbapenem antibiotic which can be administered as monotherapy for serious infections . The efficacy and safety of meropenem was compared with that of ceftazidime ( alone or in combination with amikacin ) in 153 patients with septicaemia who were enrolled into identical , prospect i ve , r and omised studies . Forty-five patients with infections arising from the urinary or lower respiratory tracts were given either meropenem 500 mg or ceftazidime 250 - 1000 mg intravenously every 8 h ; 108 patients with more serious infections were given meropenem 1 g or ceftazidime 2 g every 8 h + /- amikacin 15 mg/kg/day . Overall , 71 patients received meropenem , 47 ceftazidime and 35 ceftazidime plus amikacin . Comparable clinical response rates were achieved in the meropenem and ceftazidime/amikacin groups ( 92 % vs 94 % at the end of therapy respectively ) . Furthermore , a satisfactory bacteriological response was obtained in all evaluable patients . The most common pathogens isolated were Escherichia coli , Streptococcus pneumoniae and Pseudomonas aeruginosa . Relapse occurred in one patient in the ceftazidime/amikacin group , who had a mixed infection of E. coli and P. aeruginosa . There were no relapses in the meropenem group . Both treatments were well tolerated and only one patient had to withdraw from the trial because of an adverse effect ( rash associated with ceftazidime ) . In conclusion , these data confirm that meropenem monotherapy is well tolerated and is as effective as ceftazidime ( alone or combined with amikacin ) in the empirical treatment of septicaemia . It should prove to be a useful addition to the drugs currently available for this life-threatening disease Abstract Early initiation of empiric antibiotic therapy in febrile cancer patients has become established practice , but the appropriate duration of antibiotic therapy when no infectious source can be identified is unknown . The complications of broad-spectrum antibiotics argue for brief treatment , but the risk of an inadequately treated infection in the granulocytopenic patient favors longer therapy . We prospect ively studied 306 episodes of fever and granulocytopenia in 143 patients with leukemia or solid tumor ( age one to 33 years ) with respect to the duration of empiric antibiotic treatment . Eligible patients ( fever > 38 ° C three times/24 hours or > 38.5 ° C once , plus polymorphonuclear leukocytes 3 ) had an extensive diagnostic evaluation , including at least two preantibiotic blood cultures , and therapy was then started with a broad-spectrum antibiotic regimen— Keflin ® , gentamicin and carbenicillin ( KGC ) . Initial evaluation failed to identify an infectious etiology for the fever in 142 of 306 ( 46 per cent ) episodes . Fifty-six of 142 ( 39 per cent ) of these fevers of unknown origin were associated with persistent granulocytopenia for more than seven days ; in 33 of these , defervescence occurred while the patients received KGC . After seven days of empiric KGC therapy , the 33 patients with fevers of unknown origin who had become afebrile with empiric antibiotics but whose polymorphonuclear leukocytes remained less than 500/mm 3 were r and omized to either continue or discontinue ( dc ) to receive KGC . The patients who continued to receive KGC until their polymorphonuclear leukocytes were more than 500/mm 3 had no infectious sequelae . However , in seven of 17 ( 41 per cent ) of the patients r and omized to dc KGC infectious sequelae developed ( p = 0.007 ) within a median of two days of discontinuing KGC ( two with fever which again responded to KGC therapy , and five with a documented infection [ two ultimately fatal ] ) . In none of the patients did a resistant microbial flora or superinfection develop . These data suggest that the patient with a fever of unknown origin who becomes afebrile during empiric antibiotic therapy may profit from continued therapy while granulocytopenia persists Staphylococcus aureus is the commonest cause of acute endocarditis in intravenous drug abusers . In-vitro and in-vivo animal studies have found increased killing of organisms with the combination of a beta-lactam antibiotic and an aminoglycoside . These findings have created a controversy about the use of such combination therapy . We r and omly treated 25 episodes of S. aureus endocarditis in intravenous drug abusers with either single or combination antibiotic regimens .  Mean days to defervescence were similar in both groups : 6.3 d ( SEM , 1.49 d ) for the single drug group and 6.6 d ( SEM , 1.02 d ) for the group treated in combination with an aminoglycoside . There were no bacteriologic failures or relapses in either group . No patients needed valvular surgery , and the mortality rate was zero . Thus , it appears that single drug therapy with an appropriate beta-lactam antibiotic is adequate and appropriate in intravenous drug abusers with S. aureus endocarditis BACKGROUND Acute renal failure ( ARF ) is associated with a persistent high mortality in critically ill patients in intensive care units ( ICUs ) . Most studies to date have focused on patients with established , intrinsic ARF or relatively severe 
    Output:
    
There were no significant differences with regard to bacterial or fungal superinfections or development of antibiotic-resistant strains .
Combination therapy result ed in a significantly higher incidence of adverse events , mainly nephrotoxicity .
Overall , no clinical benefit was found for the use of a β-lactam with an aminoglycoside compared with a β-lactam alone .
Treatment with β-lactams as monotherapy entailed more antibiotic regimen modifications in open trials