amoxicillin-potassium-clavulanate-combination and Endocarditis--Bacterial

The science of antibiotic therapy for infectious diseases continues to evolve. In many instances where empiric coverage is necessary, treatment with more than one agent is considered prudent. If an etiology is identified, antibiotics are modified based on culture and susceptibility data. Even when the organism is known, more than one antibiotic may be needed. Decisions about antibiotics should be made after assessments of pertinent clinical information, laboratory and microbiology information, ease of administration, patient compliance, potential adverse effects, cost, and available evidence supporting various treatment options. Clinicians also need to consider synergy and local resistance patterns in selecting therapeutic options. In this article, the authors outline monotherapy and combination therapy options for several common infectious diseases.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cellulitis; Cephalosporins; Ciprofloxacin; Diverticulitis; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Meningitis, Bacterial; Neutropenia; Osteomyelitis; Pneumonia; Staphylococcus aureus; Viridans Streptococci

The experimental and clinical values of amoxycillin/clavulanate in severe Staphylococcus aureus infections are reviewed. Experimentally, amoxycillin/clavulanate was highly effective in the treatment of acute endocarditis due to methicillin-sensitive isolates of S. aureus (MSSA) in rats. In addition, high doses of amoxycillin/clavulanate also cured experimental endocarditis due to methicillin-resistant strains of S. aureus (MRSA) in the animal model. In the clinical setting, a review of 86 patients with either community- or hospital-acquired bacteraemia due to MSSA showed that intravenous treatment with amoxycillin/clavulanate was adequate for empirical (and apparently also long-term) therapy of such severe infections. However, the retrospective nature of the analysis did not allow assessment of the relative efficacy of amoxycillin/clavulanate as compared with standard anti-staphylococcal drugs, such as flucloxacillin or vancomycin. Further prospective studies are warranted to address this issue. Thus, amoxycillin/clavulanate appears to be a good candidate for empirical treatment of severe infections that may be caused by MSSA. Usage of amoxycillin/clavulanate against MRSA is, however, still experimental and is not currently advocated for the treatment of MRSA infections in humans.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Methicillin Resistance; Models, Biological; Rats; Staphylococcal Infections; Staphylococcus aureus

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Biofilms; Cephalosporins; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Female; Humans; Length of Stay; Male; Middle Aged; Treatment Outcome

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Echocardiography, Transesophageal; Endocarditis, Bacterial; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Moraxella; Moraxellaceae Infections; Opportunistic Infections

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arteritis; Bronchopneumonia; Ductus Arteriosus, Patent; Endocarditis, Bacterial; Equipment Failure; Female; Fever; Humans; Postoperative Complications; Prosthesis-Related Infections; Pulmonary Artery; Septal Occluder Device; Streptococcal Infections; Tomography, X-Ray Computed; Ultrasonography; Young Adult

Mechanical cardiac valve implantation was performed in 3 patients with infective endocarditis, sepsis, chronical renal insufficiency of terminal stage, to whom the programmed dialysis was conducted. The operation was performed for vital indications. All the patients after the operation are alive, their treatment was continued, using programmed hemodialysis, effect of operation is good. The success of treatment of infective endocarditis in patients with chronical renal insufficiency of terminal stage depends on timely radical elimination of the infection foci in endocardium, the intracardial and systemic hemodynamics normalization, application of etiotropic antibacterial therapy, an adequate programmed hemodialysis.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Infusion Pumps, Implantable; Kidney Failure, Chronic; Male; Renal Dialysis

To analyse clinical characteristics of endocarditis for the last 10 years, treatment difficulties and how to overcome them.. 135 patients with infectious endocarditis (IE) were examined according to the routine scheme using modern methods of diagnosis and therapy control: transthoracic and transesophageal echo-CG, test for antibiotics sensitivity of the microflora, etc. Immediate results were assessed in all the patients, some of them were followed up for maximum 5 years.. Last decade was marked for growing difficulties in the treatment of IE related to its polyetiology. It can be caused by such therapy-resistant microbes as Staphylococcus aureus, Pseudomonas aeruginosa, anaerobic infection, nosocomial infection, injections of narcotic drugs, etc.. Current course of IE dictates the necessity of fighting resistant microflora especially in case of nosocomial disease. Recurrences become more frequent. Indications to surgery did not change for the last decade. The best treatment results are achieved after antibacterial treatment of the valve.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Cephalosporins; Ciprofloxacin; Cross Infection; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Follow-Up Studies; Gentamicins; Humans; Male; Oxacillin; Plasmapheresis; Recurrence; Time Factors

A 53-year-old patient had a prosthetic valve (St. Jude Medical 25) 9 years ago because of a Staphylococcus aureus endocarditis with severe aortic regurgitation. An initially mild, progressively more severe, aortic regurgitation then developed as a result of an empty paravalvular abscess cavity, requiring another valve replacement. Fever started on the 3rd postoperative day and persisted despite combined treatment with beta-lactam antibiotics and aminoglycoside.. At first no infectious focus could be identified radiologically or by echocardiography. But transoesophageal echocardiography revealed vegetations in the old abscess cavity. Several blood cultures were negative, while serological tests gave markedly raised antibody titers against Coxiella burnetii.. Assuming Coxiella burnetii endocarditis the patient was given doxycycline, 2 x 100 mg daily and cotrimoxazole, 1 x 960 mg daily. The fever subsided and the vegetations had disappeared after four weeks. Because of the high risk of recurrence the antibiotic treatment was to be continued for two years.. Coxiella burnetii should be considered as a possible cause of fever of unknown origin, especially in patients with existing or operated cardiac valvar defects, when endocarditic vegetations have been demonstrated and several blood cultures have been negative.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Aortic Valve Insufficiency; Coxiella burnetii; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Q Fever; Recurrence; Reoperation; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of amoxycillin/clavulanic acid was compared with that of flucloxacillin, vancomycin and amoxycillin in an experimental model of Staphylococcus aureus endocarditis. Doses of the antibiotics were selected to produce peak concentrations in rat serum similar to those achievable in man after administration of parenteral therapeutic doses. Amoxycillin clavulanic acid was more effective than amoxycillin alone against endocarditis caused by beta-lactamase producing strains of Staph. aureus, illustrating the beta-lactamase inhibitory activity of clavulanic acid in vivo. Amoxycillin/clavulanic acid was as effective as flucloxacillin in these infections whereas vancomycin was generally less active. These results illustrate the clinical potential of amoxycillin/clavulanic acid in the prophylaxis, or in the therapy of severe staphylococcal infections.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Drug Therapy, Combination; Endocarditis, Bacterial; Floxacillin; Male; Rats; Species Specificity; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Vancomycin

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Cloxacillin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Methicillin; Microbial Sensitivity Tests; Penicillin Resistance; Rats; Rats, Inbred Strains; Staphylococcal Infections; Staphylococcus aureus; Vancomycin