amoxicillin-potassium-clavulanate-combination and Deglutition-Disorders

Platinum-based chemoradiotherapy for locally advanced head and neck cancer (LAHNC) induces a high rate of acute toxicity, including dysphagia and aspiration pneumonia. We hypothesised that prophylactic antibiotics can prevent pneumonia and hospitalisations and can be cost-effective.. In this multicentre randomised trial, patients with LAHNC treated with chemoradiotherapy received prophylactic amoxicillin/clavulanic acid from day 29 after the start of treatment until 14 days after completion of chemoradiotherapy or standard care without prophylaxis. The primary objective was to observe a reduction in pneumonias. Secondary objectives were to evaluate the hospitalisation rate, adverse events, costs and health-related quality of life.. One hundred six patients were included; of which, 95 were randomised: 48 patients were allocated to the standard group and 47 patients to the prophylaxis group. A pneumonia during chemoradiotherapy and follow-up until 3.5 months was observed in 22 (45.8%) of 48 patients in the standard group and in 22 (46.8%) of 47 patients in the prophylaxis group (p = 0.54). Hospitalisation rate was significantly higher in the standard group versus the prophylaxis group, 19 of 48 pts (39.6%) versus 9 of 47 pts (19.1%), respectively (p = 0.03). Significantly more episodes with fever of any grade were observed in the standard group (29.2% vs 10.2%, p = 0.028). A significant difference in costs was found, with an average reduction of €1425 per patient in favour of the prophylaxis group.. Although prophylactic antibiotics during chemoradiotherapy for patients with LAHNC did not reduce the incidence of pneumonias, it did reduce hospitalisation rates and episodes with fever significantly and consequently tended to be cost-effective.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents; Carcinoma; Chemoradiotherapy; Cisplatin; Cost-Benefit Analysis; Deglutition Disorders; Female; Head and Neck Neoplasms; Health Care Costs; Hospitalization; Humans; Male; Middle Aged; Mortality; Mucositis; Pneumonia; Quality of Life; Radiotherapy, Intensity-Modulated; Young Adult

The most common complications after surgical extraction of the third mandibular molar are trismus, oedema or swelling, local pain, dysphagia and infection. The aim of this comparative, double-blind, randomized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery. A total of 225 patients were randomized into three equal groups: placebo, prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5 mg, and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5 mg BID for 5 days. A higher rate of infection (P=0.006) was found among patients receiving placebo (16%) than those receiving single-dose prophylaxis (5.3%) or 5-day pre-emptive therapy (2.7%). A relationship between both the duration (13.8% for long versus 7.4% for medium versus 1.6% for short) and difficulty (12.7% with ostectomy versus 3.5% without ostectomy; P=0.011) of surgical procedure and incidence of subsequent infection was also observed. Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 (P=0.001). Logistic regression analysis revealed a risk of infection of 24%, 9% and 4% for ostectomy with placebo, prophylaxis and pre-emptive treatment, respectively, whereas it was 7%, 2% and 1% if ostectomy was not performed. Pre-emptive therapy with the oral sustained release amoxicillin/clavulanate formulation reduced the rate of subsequent infection in patients undergoing ostectomy. Prophylaxis was beneficial in simpler procedures and may be indicated in cases where ostectomy is not performed.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Case-Control Studies; Deglutition Disorders; Delayed-Action Preparations; Double-Blind Method; Edema; Female; Fever; Humans; Male; Middle Aged; Molar, Third; Osteotomy; Pain, Postoperative; Placebos; Postoperative Complications; Risk Factors; Surgical Wound Infection; Tooth Extraction; Treatment Outcome; Trismus

To determine the efficacy of antibacterial prophylaxis in preventing infectious complications after percutaneous endoscopic gastrostomy.. Prospective, randomised, placebo controlled, double blind, multicentre study.. Departments of internal medicine at six German hospitals.. Of 106 randomised adult patients with dysphagia, 97 received study medication, and 84 completed the study. The median age of the patients was 65 years. Most had dysphagia due to malignant disease (65%), and many (76%) had serious comorbidity.. A single intravenous 2.2 g dose of co-amoxiclav or identical appearing saline was given 30 min before percutaneous endoscopic gastrostomy performed by the thread pull method.. Occurrence of peristomal wound infections and other infections within one week after percutaneous endoscopic gastrostomy.. The incidence of peristomal and other infections within one week after percutaneous endoscopic gastrostomy was significantly reduced in the antibiotic group (8/41 (20%) v 28/43 (65%), P<0.001). Similar results were obtained in an intention to treat analysis. Several peristomal wound infections were of minor clinical significance. After wound infections that required no or only local treatment were excluded from the analysis, antibiotic prophylaxis remained highly effective in reducing clinically important wound infections (1/41 (2%) v 11/43 (26%), P<0.01) and non-wound infections (2 (5%) v 9 (21%), P<0.05).. Antibiotic prophylaxis with a single dose of co-amoxiclav significantly reduces the risk of infectious complications after percutaneous endoscopic gastrostomy and should be recommended.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Deglutition Disorders; Double-Blind Method; Drug Therapy, Combination; Gastroscopy; Gastrostomy; Humans; Middle Aged; Prospective Studies

Topics: Actinomycosis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Deglutition Disorders; Esophageal Diseases; Esophagoscopy; Heartburn; Humans; Immunocompetence; Male; Middle Aged; Penicillin G

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Deglutition Disorders; Drainage; Dysphonia; Fasciitis, Necrotizing; Humans; Male; Mediastinitis; Neck; Streptococcal Infections; Streptococcus constellatus; Tomography, X-Ray Computed

We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Clindamycin; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever of Unknown Origin; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Pneumonia, Bacterial; Sepsis; Syndrome; Thrombosis; Tomography, X-Ray Computed; Tonsillitis; Ultrasonography

In the pediatric literature, only 1 case of cervical spondylodiscitis from an ingested foreign body is reported and this was caused by a blunt radiolucent foreign body. The authors now describe a unique case of a 13-year-old teenaged boy who presented with neck pain 6 days after accidental ingestion of a sewing pin. Uncomplicated removal of this pin was followed in 36 days by the development of cervical spondylodiscitis that failed conservative management and required surgical debridement and arthrodesis. Physicians should be aware of the possibility of this complication in any patient that presents with neck pain after foreign body ingestion.

Topics: Accidents; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bone Plates; Ceftriaxone; Cervical Vertebrae; Clindamycin; Combined Modality Therapy; Deglutition Disorders; Discitis; Diskectomy; Emergencies; Equipment Contamination; Follow-Up Studies; Foreign Bodies; Humans; Laryngoscopy; Larynx; Male; Neck Pain; Oxacillin; Paresthesia; Penicillanic Acid; Pharynx; Piperacillin; Piperacillin, Tazobactam Drug Combination; Radiography; Recurrence; Retropharyngeal Abscess; Spinal Fusion; Vancomycin; Wounds, Penetrating

During the last three years, 79 adults suffering from acute epiglottitis have been treated in the ENT departments of the university hospital Rudolf Virchow, Berlin, 36 women (41 years of age as an average) and 43 men (average age 39 years). Acute epiglottitis developed either all of a sudden, within hours, or gradually, within days. All patients complained of dysphagia and pain in the throat; dyspnea could be observed in 20%. During examination, we could see an inflamed, thickened epiglottis with edema of the arytenoid cartilages. 55 patients reported an infection of the upper airway prior to the onset of symptoms of acute epiglottitis, epiglottic abscess developed in 11 adults. The inflammation responded satisfactorily to conservative antibiotic management (broad spectrum penicillin). Only one patient had to undergo intubation, none of the adults required tracheotomy.

Topics: Acute Disease; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Epiglottitis; Female; Humans; Laryngeal Neoplasms; Male; Middle Aged