amoxicillin-potassium-clavulanate-combination and Streptococcal-Infections

We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the hospital with neck pain and fever, which had persisted for 16 days prior to hospitalization. On day 1 (day of admission), blood cultures (later identifying S. constellatus) were performed, and ceftriaxone (CTRX) IV (2 g SID) was started. On day 3, suppurative thrombophlebitis of the posterior neck was diagnosed by CT scan. The antimicrobials were changed from CTRX to ampicillin/sulbactam IV (12 g QID) to guard against the possibility of complicated infection with Fusobacterium spp. or Prevotella spp. On day 17, a CT scan revealed that the thrombus remained. Therefore, oral edoxaban (30 mg SID) was started. On day 27, the patient was discharged after her medication was changed to oral amoxicillin/clavulanate (1500 mg/375 mg TID). On day 33, the amoxicillin/clavulanate was changed to oral cefaclor (1500 mg TID) and edoxaban was discontinued due to itching. On day 45, the course of cefaclor was completed. The patient went on to follow an uneventful course with no relapses or complications for two years since the conclusion of treatment. These results suggest that when a patient presents with persistent neck pain accompanied by fever, suppurative thrombophlebitis of the posterior neck should be considered. In antimicrobial therapy, the treatment could be switched from intravenous to oral. In addition, direct-acting oral anticoagulants may be an alternative to other forms of anticoagulants.

Topics: Administration, Oral; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Cefaclor; Deoxyuridine; Drug Substitution; Female; Humans; Infusions, Intravenous; Neck; Streptococcal Infections; Streptococcus constellatus; Sulbactam; Suppuration; Thrombophlebitis; Treatment Outcome

The rate of infection after a human bite is 10%-30%. Streptococcus spp. are the most common pathogens that may cause serious infections, such as necrotizing fasciitis. The authors describe a 5-year-old girl admitted to the emergency room with cellulitis due to S. pyogenes after human bites. She presented with fever and pain in her left arm, and her medical history revealed a human bite by her cousin on the arm 3 days prior. The wound culture yielded S. pyogenes. She was successfully treated with intravenous ampicillin-sulbactam regimen. S. pyogenes may cause serious wound infections following human bites. In such cases, the patient should be closely followed. Chemoprophylaxis should be initiated in an appropriate clinical setting to prevent secondary bacterial infections. This case was first reported as cellulitis due to S. pyogenes after a human bite.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arm; Bites, Human; Cellulitis; Child, Preschool; Female; Humans; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Amoxicillin/clavulanic acid 2000 mg/125 mg extended release (Augmentin XR), referred to herein as amoxicillin/clavulanic acid XR, is a pharmacokinetically enhanced formulation designed to provide more effective therapy in adults and adolescents than conventional formulations against community-acquired respiratory tract pathogens, particularly Streptococcus pneumoniae, with reduced susceptibility to amoxicillin.Amoxicillin/clavulanic acid XR maintains plasma amoxicillin concentrations >4 microg/mL for a mean of 49% of the dosing interval indicating that it would be highly effective against S. pneumoniae strains with minimum inhibitory concentrations (MICs) above the National Committee for Clinical Laboratory Standard's amoxicillin +/- clavulanic acid susceptibility breakpoint of < or = 2 microg/mL. Amoxicillin/clavulanic acid XR is at least as effective as conventional amoxicillin/clavulanic acid formulations, levofloxacin, and clarithromycin in treating community-acquired pneumonia, acute bacterial sinusitis, or acute exacerbations of chronic bronchitis, and has a tolerability profile comparable to that of conventional amoxicillin/clavulanic acid formulations. While the incidence of amoxicillin- or multidrug-resistant S. pneumoniae is not currently sufficient in most regions to warrant the routine empiric use of amoxicillin/clavulanic acid XR, the drug would be extremely useful in those regions with a high incidence of resistant pathogens or in selected patients (i.e. those with S. pneumoniae isolates having amoxicillin MICs > or = 2 microg/mL but < or = 4 microg/mL).

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Delayed-Action Preparations; Dose-Response Relationship, Drug; Humans; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Streptococcal Infections; Streptococcus pneumoniae; Treatment Outcome

Streptococcus agalactiae is a rare cause of vertebral osteomyelitis. We present four cases of spondylitis caused by this micro-organism and a review of 20 cases previously described in the literature. Only seven patients (29%) were under 50 years of age. Diabetes mellitus and neoplasms were the most frequent underlying conditions, although 37.5% of the patients did not have any predisposition. Neck or back pain was the most common symptom. Diagnosis depended mainly on magnetic resonance imaging. Blood cultures were positive in 50% of the patients. The duration of antibiotic therapy was 6 weeks for most patients. The outcome was favourable, with none of the patients suffering serious sequelae.

Topics: Abscess; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Arthroplasty, Replacement, Hip; Cefazolin; Cephalosporins; Drug Therapy, Combination; Female; Gentamicins; Hemoglobins; Humans; Leukocyte Count; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; MEDLINE; Middle Aged; Osteomyelitis; Penicillins; Radiography; Spondylitis; Streptococcal Infections; Streptococcus agalactiae

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Humans; Staphylococcal Infections; Streptococcal Infections

The combination of amoxicillin/clavulanate and metronidazole is a widely-accepted empirical regimen for infections of the odontogenic spaces. Once adequate drainage has been established micro-organisms are less likely to grow and multiply, particularly anaerobes. This may obviate the need for anaerobic coverage after drainage in healthy hosts. We studied 60 patients in this randomised prospective study, the objective of which was to evaluate metronidazole as part of an empirical antibiotic regimen after drainage of infections of the odontogenic spaces. Samples of pus were sent for culture and testing for sensitivity. Amoxicillin/clavulanate and metronidazole were given to all patients. After incision and drainage the patients were randomly allocated to two groups. In the first group both antibiotics were continued, and in the second metronidazole was withdrawn. The groups were compared both clinically and microbiologically. There were no significant differences between the groups in the resolution of infection. Thirteen patients (n=6 in the 2-antimicrobial group, and n=7 in the amoxicillin/clavulanate group) showed no improvement during the 48 h postoperatively. Overall there was need to substitute another antibiotic for amoxicillin/clavulanate in only 6 cases. Six patients in the amoxicillin/clavulanate group required the addition of metronidazole after drainage. We conclude that in healthy subjects metronidazole is not necessary in the period after drainage, but its prescription should be based on assessment of clinical and laboratory markers of infection.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Bacteriological Techniques; beta-Lactamase Inhibitors; Double-Blind Method; Drainage; Empirical Research; Focal Infection, Dental; Follow-Up Studies; Gram-Positive Bacterial Infections; Humans; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Mouth Diseases; Peptostreptococcus; Pharyngeal Diseases; Prospective Studies; Staphylococcal Infections; Streptococcal Infections; Suppuration; Young Adult

The efficacy of 3-day treatment with a combined clavulanate/amoxicillin preparation (Clavamox combination dry syrup for pediatric cases) and 10-day treatment with amoxicillin against pediatric pharyngolaryngitis and tonsillitis caused by Group A β-hemolytic Streptococcus was compared. Among the patients included in the efficacy evaluation (54 from the clavulanate/amoxicillin group and 43 from the amoxicillin group), the clinical response rate on completion of treatment was 98.1 % in the clavulanate/amoxicillin group and 92.9 % in the amoxicillin group, thus supporting the equivalent efficacy of these two therapies. The Group A β-hemolytic Streptococcus eradication rate at approximately 1-2 weeks after completion/discontinuation of treatment was 65.4 % in the clavulanate/amoxicillin group and 85.4 % in the amoxicillin group. Even in cases from which the pathogen continued to be isolated, relapse/recurrence of clinical symptoms was seldom seen. Urinalysis, conducted to assess the presence or absence of acute glomerulonephritis, revealed no abnormality in any patient. These results suggest that 3-day treatment with this clavulanate/amoxicillin preparation is expected to provide a valid means of treating pediatric pharyngolaryngitis and tonsillitis caused by Group A β-hemolytic Streptococcus.

Topics: Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Child, Preschool; Female; Humans; Infant; Laryngitis; Male; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome

The duration of therapy represents a fundamental aspect in the compliance to the therapy of child pathologies, such as pharyngotonsillitis, treated with oral therapy. Although penicillin and amoxicillin are the first choice antibiotics in the case of a child suffering from pharyngotonsillitis with the proven presence of Group A β-hemolytic Streptococcus (GAS), the number of orally administered doses and 10 days of therapy, considerably lower the compliance.. An open phase IV randomized multicenter clinical trial was conducted in parallel groups, involving 49 family pediatrician (FP), distributed over the entire national territory, enrolling 435 children suffering from GAS-FT. 210 children received Cefaclor, 50 mg/kg/day, administered twice daily for five days, whilst 213 children received amoxicillin/clavulanate 40 mg/kg/day administered twice daily for 10 days.. The results showed percentages of eradication of 88.4% for the Cefaclor group and 94.3% for the amoxicillin/clavulanate group, and a positive clinical judgement of 92.3% for the Cefaclor group and 96.6% for the amoxicillin/clavulanate group. The two arms of the study did not have any significant statistical differences, neither for the eradication, nor for the clinical judgement nor for the reduction of the Milano Score between the beginning and the end of treatment, with a P=0.042 for amoxicillin/clavulanate for eradication.. This study confirms that the administration of Cefaclor for five days during GAS-FT has the same efficacy as a 10-day therapy with amoxicillin/clavulanate, with a clearly different compliance.

Topics: Adolescent; Algorithms; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefaclor; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Male; Pharyngitis; Sicily; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Treatment Outcome

Assessment of the usefulness of antibiotic prophylaxis in inguinal hernioplasty.. This prospective randomized double blind study was conducted on 98 patients. Group A (50 patients) received a single dose of intravenous amoxicillin and clavulanic acid, and Group P (48 patients) received an equal volume of normal saline placebo by intravenous bolus 30 min before the induction of anesthesia. Hernioplasty was performed with polypropylene mesh. Skin was closed using skin staples that were removed after complete wound healing. The surgical site infection was diagnosed according to APIC, CDC criteria ( http://www.apic.org ).. The mean operative time was 38.8  ± 10.8 min in group A versus 40.9 ± 11.1 min in group P (P  = 0.34). The mean hospitalization time was 1.3 ± 0.463 days in group A versus 1.25 ± 0.438 days in group P (P = 0.58). Four patients (2%) in group A and 6 patients (2.88%) in group P had wound infections (P = 0.47). Group A had 3 superficial infections and 1 deep infection while group P had 5 superficial infections and 1 deep infection. Antibiotic treatment of the wound infection was successful in all patients. Wound culture showed Staphylococcus aureus infection in 1 patient each group, Streptococcus pyogenes in 1 group A patient and Pseudomonas aeruginosa in 1 group P patient. Cultures in other patients in both groups were reported to be sterile.. Prophylactic antibiotic usage in patients undergoing tension free inguinal hernioplasty did not show any statistically significant beneficial effects in reduction of surgical site infection.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Double-Blind Method; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Odds Ratio; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Surgical Mesh; Surgical Wound Infection; Young Adult

Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime.. To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis.. In this prospective, double-blind clinical trial, 189 patients with carcinoma of the upper aerodigestive tract were randomized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses.. An overall wound infection rate of 22% was observed. The infection rate in patients receiving cefazolin was 24% (22/92) vs. 21% (20/97) in those receiving amoxicillin-clavulanate; the difference was not statistically significant. Postoperative overall non-wound infection developed in 12% (22/189) patients; the rate of infection was 9.8% (9/92) in patients receiving cefazolin vs. 13.4% (13/97) in those receiving amoxicillin-clavulanate, without a statistically significant difference between the two groups. Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species. The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage.. In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin. However, when taking into account the fact that beta-lactamase containing strains have recently been spreading, amoxicillin-clavulanate should be the logical first choice.

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bronchitis; Carcinoma, Squamous Cell; Cefazolin; Double-Blind Method; Head and Neck Neoplasms; Humans; Injections, Intravenous; Laryngeal Neoplasms; Mouth Neoplasms; Pharyngeal Neoplasms; Pneumonia, Bacterial; Postoperative Complications; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection; Tracheitis

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drug Administration Schedule; Haemophilus Infections; Haemophilus influenzae; Humans; Maxillary Sinusitis; Radiography; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes

Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis.. The bacteriologic and clinical efficacies of clarithromycin [30 or 15 mg/kg/day twice daily (b.i.d.)] or amoxicillin/clavulanate (43.8/6.2 mg/kg/day b.i.d.) for 5 days or penicillin V (30 mg/kg/day 3 times a day) for 10 days were compared. In a randomized, open label, parallel group, multicenter study, 626 children (2-16 years old) with tonsillopharyngitis were enrolled; 537 were evaluable for efficacy. Follow-up evaluations were performed at 4-8 and 21-28 days after therapy.. At enrollment, 26% of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible. All regimens had an apparently similar clinical efficacy. The long term S. pyogenes eradication rates were 102 of 123 (83%) with amoxicillin/clavulanate and 88 of 114 (77%) with penicillin V. In the 30- and 15-mg/kg/day clarithromycin groups, eradication occurred in 71 of 86 (83%) and 59 of 80 (74%) of the clarithromycin-susceptible isolates (P = 0.33), and in 4 of 28 (14%) and 5 of 26 (19%) of the clarithromycin-resistant isolates, respectively (clarithromycin-susceptible versus -resistant, P < 0.0001). Both clarithromycin dosages were well-tolerated.. In group A streptococcal tonsillopharyngitis, 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable with that of 10 days of penicillin V treatment; however, amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin because of its failure to eradicate the clarithromycin-resistant S. pyogenes isolates. The 5-day clarithromycin regimens are not recommended for treatment of streptococcal tonsillopharyngitis in areas where in vitro resistance of group A streptococci to clarithromycin is common.

Topics: Acute Disease; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Child; Child, Preschool; Clarithromycin; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Penicillin V; Pharyngitis; Probability; Reference Values; Risk Assessment; Severity of Illness Index; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome

Pharyngotonsillitis (PT) caused by group A beta hemolytic streptococci (GABHS) is one of the most common infections of childhood. Two antibiotic suspensions, cefaclor (CEF) and amoxicillin/clavulanate (AMC), are commonly used in Poland for the treatment of PT caused by GABHS in children.. This multi-center, randomized, single-blinded study was undertaken in order to compare the efficacy and safety of CEF (20 mg/kg/d) and AMC (25 mg/kg/d) in 10 days treatment of GABHS-related PT. 100 children (mean age 6 years) were enrolled into the study. Clinical and bacteriological assessments were done on the 14-18 th, and 38-45 th days after randomization.. No GABHS strain isolated from throat smears was resistant in vitro to both antibiotics. Both antibiotics had almost 98% effectiveness at the post therapy visit. On follow-up, significantly more relapses and recurrences were observed in the AMC-treated group than in the CEF-treated group (relapse rate 21.28% vs 15.56%, p<0.02, recurrence 10.64% vs 6.66%, p<0.002). The relapse odds ratio in the AMC group was 1.7 times greater than in the CEF group, and recurrence was 1.5 times higher. There were significantly higher rates of gastrointestinal adverse events in children treated by AMC (p<0.02).. CEF provides a clinically and bacteriologically effective treatment for children with PT caused by GABHS, comparable to AMC but significantly safer in terms of gastrointestinal side effects. AMC shows a greater risk of relapse and recurrence than CEF.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefaclor; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Pharyngitis; Recurrence; Safety; Single-Blind Method; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis

Topics: Amoxicillin-Potassium Clavulanate Combination; Azithromycin; Cefixime; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Nasopharynx; Pharyngitis; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

The efficacy of a new pharmacokinetically enhanced formulation of amoxycillin/clavulanate (AMX/CA) 2000/125 mg, twice daily, designed to provide adequate levels of amoxycillin over the 12-h dosing interval to eradicate penicillin-resistant Streptococcus pneumoniae (PRSP) with amoxycillin (+/-clavulanic acid) MICs of /=4 mg/l. In the pooled comparator group, the success rate at follow-up was 86.5% (45/52). For PRSP (AMX/CA MICs of 0.5-8 mg/l), the overall success rate was 98.2% (55/56) at follow-up for AMX/CA 2000/125 mg and 50.0% (2/4) for comparators. AMX/CA 2000/125 mg shows efficacy comparable to that of the comparators evaluated against S. pneumoniae infections. Due to its favorable pharmacokinetic/pharmacodynamic profile and promising clinical success, the new AMX/CA 2000/125 mg formulation should be considered for the empirical treatment of respiratory tract infections in regions with a high prevalence of antimicrobial-resistant S. pneumoniae and in patients at high risk of antimicrobial-resistant S. pneumoniae infection as this formulation covers many PRSP that are non-susceptible to amoxycillin (+/-clavulanic acid) (MICs of >/=4 mg/l) as well as common beta-lactamase-producing respiratory pathogens.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bronchitis; Double-Blind Method; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multicenter Studies as Topic; Pneumonia, Bacterial; Respiratory Tract Infections; Streptococcal Infections; Streptococcus pneumoniae; Treatment Outcome

One hundred and sixty-five consecutive patients ( > 2 years of age) with acute group A streptococcal (GAS) pharyngitis randomly received co-amoxyclav (79 patients) or phenoxymethyl penicillin (86 patients). beta-Lactamase activity in saliva was determined for each patient. At follow up after seven days, tonsillar cultures from seven patients (9.6%) in the penicillin V group grew group A streptococcus; three of these patients had tonsillitis clinically. In the co-amoxiclav group these figures were three (3.8%) and two respectively (P > 0.05). Within the 12 month follow up period, there were four clinical recurrences (6.1%) in the penicillin V group and seven (9.3%) in the co-amoxiclav group (P > 0.1). beta-Lactamase activity in the saliva was demonstrated in 29 patients (19.2%). Fourteen (74%) of 19 bacteriological failures or clinical recurrences had beta-lactamase activity, versus 15 (12%) of 129 successfully treated patients (P < 0.001). There is no evidence that oral co-amoxiclav is better than oral penicillin V for the first treatment of acute GAS pharyngitis, but bacteriological failure and clinical recurrence are strongly associated with the presence of beta-lactamase activity in commensal flora.

Topics: Acute Disease; Adolescent; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamases; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Penicillin V; Penicillins; Pharyngitis; Saliva; Streptococcal Infections

Because production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure, we studied the effect of anaerobic and aerobic beta-lactamase-producing bacteria on bacteriologic outcome in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis. We compared 10-day courses of orally administered phenoxymethyl penicillin and amoxicillin-clavulanic acid, using a randomized, single-blind treatment protocol. Eligible patients were 2 to 16 years of age and had culture-proven acute GABHS pharyngitis; 89 patients (43 penicillin, 46 amoxicillin-clavulanic acid) were compliant with therapy. beta-Lactamase-producing organisms were isolated before therapy from the throats of 67% of patients treated with penicillin and 63% treated with amoxicillin-clavulanic acid. Throat cultures after completion of therapy were positive for GABHS in 7 (7.9%) of 89 patients. The initial GABHS T type persisted (treatment failure) in only 4 (4.5%) of 89 patients, including 3 (6.5%) of 46 who received amoxicillin-clavulanic acid and in 1 (2.3%) of 43 who received penicillin (not statistically significant). Bacteriologic treatment failure was unrelated to recovery of beta-lactamase-producing bacteria at the time of enrollment or after treatment. We conclude that beta-lactamase production by normal pharyngeal flora does not fully explain the failure of penicillin therapy for acute streptococcal pharyngitis. Using an antibiotic effective against beta-lactamase-producing bacteria will not eliminate the problem of bacteriologic treatment failure.

Topics: Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacteria, Aerobic; Bacteria, Anaerobic; beta-Lactamases; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Humans; Penicillin V; Pharyngitis; Pharynx; Serotyping; Single-Blind Method; Streptococcal Infections; Streptococcus pyogenes

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Female; Humans; Insect Bites and Stings; Psychodidae; Skin; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Abdominal Pain; Adult; Amoxicillin-Potassium Clavulanate Combination; Biopsy, Needle; Esomeprazole; Female; Fever; Gastritis; Gastroscopy; Humans; Immunohistochemistry; Infusions, Intravenous; Prognosis; Rare Diseases; Severity of Illness Index; Streptococcal Infections; Tomography, X-Ray Computed; Treatment Outcome; Vomiting

Primary peritonitis, a bacterial infection within the peritoneal cavity that arises in the absence of an intraperitoneal source, is a rare entity in paediatrics. We describe the case of a previously healthy 11-year-old girl who presented with an acute abdomen and was found to have primary peritonitis due to

Topics: Abdomen, Acute; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Appendectomy; Child; Female; Humans; Peritoneal Cavity; Peritonitis; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Acute Disease; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Female; Humans; Metronidazole; Parotitis; Self Medication; Streptococcal Infections; Tomography, X-Ray Computed; Viridans Streptococci

Incidence and severity of invasive group A Streptococcus infections are of increasing concern in France and worldwide. The risk for secondary infection of close contacts is known but rarely described. We report a case of intrafamilial and life-threatening transmission of emm12 group A Streptococcus.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bursitis; Contraindications, Drug; Disease Transmission, Infectious; Fasciitis, Necrotizing; Female; Humans; Male; Spouses; Streptococcal Infections; Streptococcus pyogenes

Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment.. To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children.. A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score-matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts.. Broad-spectrum antibiotics vs narrow-spectrum antibiotics.. In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events.. Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, -0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868 (35%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotics were associated with a slightly worse child quality of life (score of 90.2 for broad-spectrum antibiotics vs 91.5 for narrow-spectrum antibiotics; score difference for full matched analysis, -1.4% [95% CI, -2.4% to -0.4%]) but not with other patient-centered outcomes. Broad-spectrum treatment was associated with a higher risk of adverse events documented by the clinician (3.7% for broad-spectrum antibiotics vs 2.7% for narrow-spectrum antibiotics; risk difference for full matched analysis, 1.1% [95% CI, 0.4% to 1.8%]) and reported by the patient (35.6% for broad-spectrum antibiotics vs 25.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 12.2% [95% CI, 7.3% to 17.2%]).. Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Female; Humans; Macrolides; Male; Otitis Media; Pharyngitis; Primary Health Care; Quality of Life; Respiratory Tract Infections; Retrospective Studies; Sinusitis; Streptococcal Infections; Streptococcus pyogenes; Treatment Failure

The management of sore throat varies widely in Europe. The objective of this study was to gain insight into clinicians' perceptions on the current management of sore throat in Spain.. Cross-sectional, internet-based questionnaire study answered from July to September 2013. General practitioners (GPs) affiliated with the two largest scientific societies of primary care were invited to participate in the study. Questions were asked about physician knowledge, the use of current national guidelines for sore throat management, and management in two clinical scenarios, depicting a young adult with sore throat and: 1. cough, coriza with or without fever, and 2. fever without cough and coriza.. The questionnaire was completed by 1476 GPs (5%) and 12.7% declared using rapid antigen detection tests. Antibiotics were considered by 18.8% of the GPs in the first scenario and by 32% in the second scenario (p < 0.001). The antibiotics most commonly mentioned by GPs were amoxicillin and amoxicillin + clavulanate (52.7 and 31.2%, respectively) whereas penicillin V was only prescribed in 11.9% of the cases. The drugs most commonly considered in both scenarios were analgesics and anti-inflammatory drugs. Antitussives, decongestants and expectorants were more commonly prescribed in cases of suspected viral infection (p < 0.001).. GPs have misconceptions as to the indications for using rapid antigen detection tests and prescribing drugs in the management of sore throat. These results suggest that guidelines are seldom followed since one in five GPs declared giving antibiotics for patients with a suspected viral infection and the use of second-choice antibiotics seems considerable.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Analgesics; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antigens, Bacterial; Attitude of Health Personnel; Cross-Sectional Studies; Disease Management; General Practitioners; Humans; Internet; Penicillin V; Pharyngitis; Practice Patterns, Physicians'; Spain; Streptococcal Infections; Streptococcus pyogenes; Surveys and Questionnaires

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Autoimmune Diseases; Child, Preschool; Female; Humans; Obsessive-Compulsive Disorder; Streptococcal Infections; Treatment Outcome

Cutaneous larva migrans (CLM) is a parasitosis frequently seen in persons who have travelled to tropical or subtropical regions and in those who have worked in contact with soil. The disease frequently develops due to Ancylostoma braziliensis and Ancylostoma caninum species. After penetrating the skin and entering the body, the hookworm larva proceeds to bore tunnels through the epidermis, creating pruritic, erythematous, serpiginous lesions. Secondary bacterial infections of the lesions can often be seen, especially on the legs and buttocks. In this article we presented three atypical local cases which have not been declared previously in our country. The first case, a 54-year-old male who was admitted to hospital in August with complaints of an obverse body rash and itching lasting for a week. Eruptions were observed over a small area on the right side of the abdomen, consisting of itchy, raised, erythematous, curvilinear string-like lesions. Moreover, no eosinophilia was detected in the patient, whose culture showed a growth of Streptococcus pyogenes. The patient was clinically diagnosed with CLM accompanied by secondary bacterial infection and treated for three days with 1 g of amoxicillin-clavulanic acid, mupirocin cream and albendazole 400 mg/d. Under this regime, the lesions were seen to decline. The second case, a 38-year-old male was also admitted in August, complaining of itching and redness on his body. The patient, whose blood count values were normal, exhibited itchy, raised, serpiginous string-like lesions located on the left side of his body. The patient, whose bacterial culture was negative, was clinically diagnosed as CLM and treated for three days with albendazole 400 mg/d and the lesions were seen to improve. The third case, a 23-year old male was admitted in September complaining of itching and redness on his neck. An itchy, crescent-shaped erythematous lesion was detected on his neck; bacteriological cultures and blood count were normal. The common feature for all three cases was the story of working in a hazelnut orchard and mowing weeds using a motorized string trimmer (weed whacker). None of them had a history of travel outside the country. Therefore CLM assumed to be occurred due to the aeration of surface earth layer with the force of motorized string trimmer and entrance of the larvae were from the open parts of the body. In conclusion, it should be keep in mind that hookworm larva-related CLM can be encountered in our country,

Topics: Adult; Agricultural Workers' Diseases; Albendazole; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antinematodal Agents; Humans; Larva Migrans; Male; Middle Aged; Mupirocin; Streptococcal Infections; Streptococcus pyogenes; Turkey; Young Adult

Tonsillitis and pharyngitis are among the most common infections in the head and neck. Viral tonsillitis is usually caused by enterovirus, influenza, parainfluenza, adenovirus, rhinovirus and Epstein-Barr virus (causing infectious mononucleosis). Acute bacterial tonsillitis is most commonly caused by group A beta-hemolytic streptococci. On the other hand, pseudomembranous and necrotizing tonsillitis are usually caused by fusiform bacilli and spirochetes. Here we report what is, to our knowledge, the first case of necrotizing tonsillitis caused by group C beta-hemolytic streptococci.

Topics: Amoxicillin-Potassium Clavulanate Combination; Humans; Male; Necrosis; Streptococcal Infections; Streptococcus; Tonsillitis; Young Adult

We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate.. Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively.. Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S.aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Māori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S.pneumoniae pleural antigen were important in diagnosis.. Our audit confirms the important role of S.aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendation.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Child; Child, Preschool; Cohort Studies; Community-Acquired Infections; Empyema, Pleural; Ethnicity; Female; Floxacillin; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; New Zealand; Pneumococcal Infections; Practice Guidelines as Topic; Retrospective Studies; Seasons; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drug Hypersensitivity; Erythema Multiforme; Humans; Infant; Male; Pharyngitis; Risk Assessment; Streptococcal Infections

Periorbital infections after strabismus surgery are rare. We describe the first reported case of necrotizing group A streptococcal infection of the conjunctiva and Tenon's capsule complicating uneventful strabismus surgery in a 23-month-old boy, successfully managed with conservative intraoperative debridement and with targeted local and systemic antibiotics.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Conjunctivitis, Bacterial; Esotropia; Eye Infections, Bacterial; Fasciitis, Necrotizing; Humans; Infant; Male; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Penicillin G; Streptococcal Infections; Streptococcus pyogenes; Tenon Capsule; Trimethoprim, Sulfamethoxazole Drug Combination

This study aims to determine the asymptomatic bacteriuria in pregnancy due to GBS and its antimicrobial sensitivity pattern for planning strategy for the management of these cases and also to determine the relationship between asymptomatic bacteriuria and pyuria. A total of 3863 consecutive urine specimens were collected from 3863 pregnant women with asymptomatic bacteriuria attending the obstetrics and gynaecology department of our hospital over a period of two years. Specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. The prevalence of asymptomatic bacteriuria due to group B streptococci (GBS) was 82/3863 (2.1%) among pregnant women in Saudi Arabia. Among these, 69/82 patients (84.2%) had clinical and microbiological features consistent with cystitis, versus 13/82 (15.8%) for pyelonephritis. About 51.2% (42/82) of the patients who had urine analysis performed had positive results based on positive urinary leucocyte esterase and pyuria. Disc-diffusion analysis of all 82 GBS isolates showed that they were highly susceptible to Augmentin and linezolid. Screening for bacteriuria in pregnancy and proper treatment must be considered as an essential part of antenatal care in this community. To prevent asymptomatic bacteriuria complications, all pregnant women should be screened at the first antenatal visit. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. Further, ongoing surveillance and evaluation of outcomes in pregnancies complicated by GBS bacteriuria is required to optimise maternal and newborn care.

Topics: Acetamides; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Cystitis; Female; Humans; Linezolid; Microbial Sensitivity Tests; Middle Aged; Oxazolidinones; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Pyelonephritis; Pyuria; Saudi Arabia; Streptococcal Infections; Streptococcus agalactiae

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cutaneous Fistula; Dacryocystitis; Disease Susceptibility; Female; Fistula; Humans; Infant; Infectious Mononucleosis; Lacrimal Apparatus Diseases; Streptococcal Infections; Streptococcus pneumoniae

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Topics: Abscess; Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Catheterization, Central Venous; Cefotaxime; Clavicle; Female; Fever of Unknown Origin; Follow-Up Studies; Fosfomycin; Fractures, Spontaneous; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Male; Osteomyelitis; Pregnancy; Pregnancy Complications, Infectious; Radionuclide Imaging; Sepsis; Streptococcal Infections; Ultrasonography

The aim of this study was to investigate the microbiology of secondary bacterial peritonitis due to appendicitis and the appropriateness of current antimicrobial practice in one institution.. A 14-year retrospective single-centre study of 69 consecutive paediatric patients (age 1-14 years) with appendicitis-related peritonitis and positive peritoneal specimen cultures was conducted. Post-operative outcomes, microbiology and antibiotic susceptibility of peritoneal isolates were analysed in all patients.. Escherichia coli was identified in 56/69 (81 %) peritoneal specimens; four isolates were resistant to amoxicillin-clavulanate, and one other isolate was resistant to gentamicin. Anaerobes were identified in 37/69 (54 %) peritoneal specimens; two anaerobic isolates were resistant to amoxicillin-clavulanate and one isolate was resistant to metronidazole. Pseudomonas aeruginosa was identified in 4/69 (6 %) peritoneal specimens, and all were susceptible to gentamicin. Streptococcal species (two Group F streptococci and three β-haemolytic streptococci) were identified in 5/69 (7 %) specimens, and all were susceptible to amoxicillin-clavulanate. Combination therapy involving amoxicillin-clavulanate and aminoglycoside is appropriate empirical treatment in 68/69 (99 %) patients. Addition of metronidazole to this regime would provide 100 % initial empirical coverage. Inadequate initial empiric antibiotic treatment and the presence of amoxicillin-clavulanate resistant E. coli were independent predictors of the post-operative infectious complications observed in 14/69 (20 %) patients.. E. coli and mixed anaerobes are the predominant organisms identified in secondary peritonitis from appendicitis in children. Inadequate initial empirical antibiotic and amoxicillin-clavulanate resistant E. coli may contribute to increased post-operative infectious complications. This study provides evidence-based information on choice of combination therapy for paediatric appendicitis-related bacterial peritonitis.

Topics: Adolescent; Aminoglycosides; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Appendicitis; Child; Child, Preschool; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Gentamicins; Humans; Infant; Male; Metronidazole; Peritonitis; Pseudomonas aeruginosa; Pseudomonas Infections; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae

It is common surgical practice to take a specimen for microbial culture and sensitivity when incising and draining infections of odontogenic origin in the head and neck. We aimed to find out if routine testing has any therapeutic value. We retrospectively studied 90 patients (57 male and 33 female) admitted to Northampton General Hospital for treatment of odontogenic infections, and reviewed admission details, antimicrobial treatment, microbiological findings and their sensitivity or resistance, and complications. Specimens were sent from 72 (80%) patients of which 61 (85%) were infected. The most commonly isolated organism was Streptococcus viridans. Interim reports were published after a mean of 3 days (range 1-4), and 94% of patients were discharged within a mean of 2 days (range 0-9) postoperatively. Almost 95% of patients were discharged before results were available, and there were no reported complications. We therefore suggest that microbial culture has little therapeutic value in the management of these patients. With culture and sensitivity tests costing £25 - £30, omission of this practice in the case of uncomplicated (single tissue space) odontogenic infections could save resources in the National Health Service without affecting the care of patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Child; Child, Preschool; Drainage; Female; Follow-Up Studies; Humans; Infant; Length of Stay; Male; Metronidazole; Middle Aged; Retrospective Studies; Smoking; Streptococcal Infections; Tooth Diseases; Viridans Streptococci; Young Adult

Brain abscess is a serious life-threatening infection of the brain parenchyma. We are reporting a rare case of brain abscess caused by Group G Streptococcus in a 12 year-old female child who presented with neurological symptoms. She was diagnosed with congenital anomalies of the heart at birth. She was treated with amoxyclav and ciprofloxacin. The child recovered and was discharged uneventfully.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Brain; Brain Abscess; Child; Ciprofloxacin; Female; Humans; Magnetic Resonance Imaging; Radiography; Streptococcal Infections; Streptococcus; Treatment Outcome

Necrotising fasciitis is a rapidly progressive, aggressive bacterial infection of the subcutis associated with significant morbidity and mortality in both man and domestic animals. To the best of our knowledge, this is the first veterinary report of magnetic resonance imaging findings in necrotising fasciitis, and the first reported case in a dog to be successfully treated with minimally invasive surgical intervention.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Dog Diseases; Dogs; Drainage; Fasciitis, Necrotizing; Female; Radiography; Streptococcal Infections; Streptococcus

Topics: Abscess; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Diagnosis, Differential; Humans; Male; Neck Pain; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Thyroid Diseases; Thyroid Gland; Tomography, X-Ray Computed; Ultrasonography

Pustulosis acuta generalisata is an uncommon condition characterized by scattered symmetrical eruption of sterile pustules associated with elevated inflammatory markers, leukocytosis, fever and arthropathy caused by previous infection by group A streptococci (GAS). We reported here a case of pustulosis acuta generalisata in an HIV-positive patient recently treated with chemotherapy for a seminoma.

Topics: Acute Generalized Exanthematous Pustulosis; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; HIV Infections; Humans; Male; Seminoma; Streptococcal Infections; Streptococcus pyogenes; Testicular Neoplasms; Treatment Outcome

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthritis, Infectious; Clindamycin; Debridement; Female; Humans; Knee Prosthesis; Prosthesis-Related Infections; Reoperation; Streptococcal Infections; Streptococcus bovis

Streptococcus pneumoniae usually produces infection of the respiratory tract, inner ear or meninges. Unusual sites of infection have rarely been reported among HIV-1 seropositive patients. We report a case of post auricular subcutaneous abscess caused by Streptococcus pneumoniae in a Human Immunodeficiency Virus (HIV) infected child who also had B cell lymphoma. This case is uncommon as there was no other documented primary focus of pneumococcal infection or a preceding history of bacteraemia or respiratory infection.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; HIV Seropositivity; Humans; Lymphoma, B-Cell; Male; Skin Diseases, Bacterial; Streptococcal Infections; Streptococcus pneumoniae

Although perianal streptococcal dermatitis (PSD) is well known in children, it has only rarely been documented in adults. The incidence and necessity for treatment may be underestimated. We have retrospectively identified adult patients with perianal streptococcal dermatitis.. Patients with streptococcal anal dermatitis were identified from a prospective office database. Treatment was with oral antibiotics according to the organism sensitivity. Additional concomitant anorectal disease was treated according to standard guidelines. Patients were compared with a control group, without eczema or erythema, for the presence of β-haemolysing Streptococci on perianal swab. Demographic and microbiological data were assessed and compared between and within treatment and control groups.. Fifty-three (22 female) patients older than 20 (mean = 49) years of age were diagnosed with perianal streptococcal dermatitis between 2005 and 2009. In most cases group B β-haemolytic Streptococci were found. Fifty patients received antibiotics for 14 days. In 28 of 33 patients who had a post-treatment swab, the result was negative. Five patients showed Streptococci of different groups in the post-treatment swab. Of the 50 patients, 21 (42%) had no further anorectal complaint and 29 (58%) required continuing treatment for another anorectal condition. In the control group β-haemolysing Streptococcus was found in 34%. Men over 60 years of age more often required no further anorectal treatment compared with women (P < 0.05).. Perianal streptococcal dermatitis occurs in adult patients more often than reported. It is mainly caused by group B β-haemolysing Streptococcus. Its diagnosis is important because it can cause serious systemic infections, especially in the elderly and in newborns. Antibiotics resolve the condition in a high proportion of patients.

Topics: Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anal Canal; Anti-Bacterial Agents; Case-Control Studies; Eczema; Female; Humans; Male; Middle Aged; Pruritus Ani; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae

Topics: Abscess; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Combined Modality Therapy; Continuous Positive Airway Pressure; Disease Progression; Humans; Male; Masks; Parotid Diseases; Parotid Gland; Polysomnography; Pressure; Sialadenitis; Sleep Apnea, Obstructive; Streptococcal Infections; Streptococcus anginosus

Although the risk of developing osteonecrosis of the jaw for oral implants in patients using oral bisphosphonates (BPs) is low, the devastating complications still require caution. We document a case of severe periimplant infection that developed after the patient had used oral BPs for 3 years. Exposed bone and osteonecrosis persisted for more than 2 months after 1 infected implant was explanted by a dentist unaware that the patient was taking BPs. After oral BPs had been stopped, another involved implant was explanted, sequestra were removed, a primary closure was sutured, and the antibiotic was changed; then the wound was finally under control. The explanted implant with attached bone was processed for undecalcified ground sections, and specimens from the bony lesion were sent to pathology for examination. Osteonecrosis, severe inflammatory osteolysis, and heavy bacterial colonization were found. Patients at risk must be alerted about the potential risks of implant failure and developing BP-related osteonecrosis of the jaw.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bisphosphonate-Associated Osteonecrosis of the Jaw; Dental Implants; Dental Restoration Failure; Device Removal; Fusobacterium Infections; Humans; Male; Peri-Implantitis; Prosthesis-Related Infections; Streptococcal Infections; Viridans Streptococci

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Female; Humans; Middle Aged; Streptococcal Infections; Streptococcus agalactiae; Vulvar Diseases

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

The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortic Dissection; Bacteremia; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Esophageal Fistula; Fever; Humans; Ischemia; Male; Middle Aged; Myocardial Infarction; Paraplegia; Penicillins; Postoperative Complications; Prosthesis-Related Infections; Radiography; Spinal Cord; Streptococcal Infections; Vascular Fistula; Viridans Streptococci

Streptococcus agalactiae is not only a well-known cause of severe infections in the first 3 months of life but also an unusual organism to be isolated in case of septic arthritis, especially in children. We report a case of a monoarticular arthritis in a 6-month-old girl.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthralgia; Arthritis, Infectious; Ceftriaxone; Female; Humans; Infant; Knee Joint; Rifampin; Streptococcal Infections; Streptococcus agalactiae; Ultrasonography

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

Topics: Abdominal Abscess; Adenocarcinoma; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Colorectal Neoplasms; Eikenella corrodens; Female; Gram-Negative Bacterial Infections; Haemophilus Infections; Hernia, Ventral; Humans; Intestinal Obstruction; Intestine, Small; Intraoperative Complications; Ofloxacin; Streptococcal Infections; Surgical Wound Infection; Tissue Adhesions

Acute bacterial parotitis is a rare infectious disease in infants under 3 months of age.. To describe the clinical characteristics and the course of acute bacterial parotitis in infants less than 3 months old.. Infants under 3 months of age, hospitalized at Robert Debré university hospital, Paris, France, between January 2005 and December 2009 for acute bacterial parotitis, were included in a retrospective study.. Five infants less than 3 months of age were included in this study, for a frequency of 2.5/1000 hospitalizations in this age group. All were born at term, 4 of 5 were male. Three of the 5 patients had specific clinical signs of parotitis on admission. One patient had septic shock on admission. The ultrasound confirmed the parotitis in all cases. No parotid abscess was demonstrated on imaging. All patients had at least one abnormal inflammatory biological test (WBC, CRP, PCT). Bacteria were identified in 4 of 5 cases: Staphylococcus aureus was isolated in the pus culture of the Stenon duct in 2 patients and a group B Streptococcus was isolated from blood culture of 2 other patients. The duration of intravenous antibiotic therapy varied from 4 to 13 days, and the total duration of antibiotic therapy was between 10 and 16 days. No surgical procedures were needed.. Acute bacterial parotitis in infants under 3 months of age might be associated with localized infections due to S. aureus, but also with a more severe clinical presentation due to group B streptococcus infection. Early diagnosis and appropriate antibiotic therapy might prevent the progression to serious complications.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Female; Hospitals, Pediatric; Hospitals, University; Humans; Infant; Male; Parotitis; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

The necrotizing fasciitis (NF) is a soft tissue infection affecting the superficial fascia, the subcutaneous tissue and the skin, the latter being affected tardively. This diagnosis is confirmed only after surgery, which consists of debridement of the necrotized tissue. The discordance between the symptomatology and physical exam made that the diagnosis is mistaken in 35% of cases. However, it seems important to remember that the prompt recognition and surgical treatment depend on the morbidity and mortality. We report the case of a patient with NF of the upper limb after a right elbow blunt trauma.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Fasciitis, Necrotizing; Female; Humans; Middle Aged; Skin Transplantation; Streptococcal Infections; Streptococcus pyogenes; Wounds, Nonpenetrating

Orofacial space infections are common presentations in maxillofacial clinics even in the post-antibiotic era. One of the main factors determining the spread of infection is the host defense mechanism. Diabetes is one of the most common systemic illness suppressing the immunity of an individual and increasing their susceptibility to infections. This study was carried out to compare the spaces involved, the severity of infection, the virulent organism, the efficacy of empirical antibiotics, the length of hospital stay, and the complications encountered in the management of maxillofacial space infection of odontogenic origin in diabetic patients as compared with nondiabetic patients.. A 4-year prospective study was carried out on patients with maxillofacial space infection of odontogenic origin. The patients were divided into 2 groups on the basis of presence or absence of diabetes.. A total of 111 patients were identified out of which 31 were diabetic. The organisms commonly isolated were Streptococcus species with submandibular space being the most common space involved in both the groups. The empirical antibiotic used was amoxicillin plus clavulanic acid combined with metrogyl in 70.27% cases.. Streptococcus species is still the most common causative pathogen irrespective of the diabetic status of the patient. The same empirical antibiotic therapy of amoxicillin plus clavulanic acid combined with metrogyl along with hyperglycemia control and surgical drainage of infection yielded satisfactory resolution of infection in the diabetic patients as well.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Case-Control Studies; Diabetes Complications; Drainage; Drug Combinations; Focal Infection, Dental; Humans; Hyperglycemia; Klebsiella Infections; Length of Stay; Ludwig's Angina; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Mouth Diseases; Prospective Studies; Streptococcal Infections

Retropharyngeal abscess is an uncommon entity that can have severe and even fatal complications if it is not identified and treated early. Clinical and radiologic findings must be considered together prior to surgical drainage of a suspected retropharyngeal abscess. Airway obstruction may require emergent surgical management with tracheotomy. We describe the case of a 22-year-old man with a massive retropharyngeal abscess that was caused by inadequate treatment of acute tonsillitis. He responded well to surgical drainage and empiric antibiotic therapy.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Humans; Male; Retropharyngeal Abscess; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Young Adult

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Combined Modality Therapy; Diagnosis, Differential; Dyspnea; Emergencies; Esophageal Neoplasms; Esophageal Stenosis; Fever of Unknown Origin; Fusobacterium Infections; Humans; Male; Mediastinitis; Streptococcal Infections; Streptococcus anginosus; Therapeutic Irrigation; Tomography, X-Ray Computed

The skin infections are common in pediatrics, ranging from furonculosis or impetigo to the severe forms of necrotizing dermohypodermitis. The general antibiotic treatments are not always indicated but when they are, they must take into account the resistance of two main species of bacteria (Staphylococcus aureus and Streptococcus pyogenes), the pharmacokinetics-pharmacodynamic parameters and the severity and type of infection. Two situations should be treated by topical treatements: limited impetigo and furonculosis. The two topical antibiotics used preferentially are mupirocine and fucidic acid. Soon, a third topical antibiotic, reptamuline will complete these. For uncomplicated superficial skin infections justifying an oral antibiotic, amoxicillin-clavulanate offers the best guarantee of efficiency. Poor pharmacodynamic-pharmacokinetic must lead to not prescribe oral M penicillins. In case of allergy, a first-generation cephalosporin, a macrolide (if the susceptibility of the strain was checked) or pristinamycine (after 6 years of age) are acceptable alternatives. For dermohypodermitis bacterial antibiotic of choice remains amoxicillin-clavulanate through IV route, to be active against S. pyogenes but also S. aureus and anaerobic bacteria. The IV route is maintained until regression general signs and a relay orally by the same drug is then possible. For toxinic syndromes and necrozing fascitis clindamycin should be added to a beta-lactam because of its action on protein synthesis in particular reducing the toxins production.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cellulitis; Cephalosporins; Child; Drug Resistance, Bacterial; Fasciitis, Necrotizing; Furunculosis; Fusidic Acid; Humans; Impetigo; Injections, Intravenous; Macrolides; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Penicillins; Pristinamycin; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Scalded Skin Syndrome; Staphylococcal Skin Infections; Staphylococcus aureus; Stevens-Johnson Syndrome; Streptococcal Infections; Streptococcus pyogenes

Non-traumatic nasal septal abscess is rare, commonly seen in patients with poor immunity, and presents as isolated nasal septal abscess. Further, nasal septal abscess complicated with acute sinusitis is rather rare. Very little literature has been generated for non-traumatic nasal septal abscess complicated with acute sinusitis in healthy patients. Prompt diagnosis and adequate treatment will help to prevent the complications associated with nasal septal abscess such as saddle nose and intracranial involvement. Herein, to our knowledge, we present the first case involving an otherwise healthy little girl with nasal septal abscess complicated with acute sinusitis and facial cellulitis.

Topics: Abscess; Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Cellulitis; Cheek; Child; Ethmoid Sinusitis; Eyelid Diseases; Female; Humans; Maxillary Sinusitis; Nasal Obstruction; Nasal Septum; Nose Diseases; Postoperative Care; Streptococcal Infections; Tomography, X-Ray Computed; Viridans Streptococci

Inadequate treatment or neglect of odontogenic infections can have serious consequences. The potential for spreading through fascial planes and intracranially can cause compromise of the airway and cavernous sinus thrombosis respectively. On rare occasions this can lead to a rapidly progressing necrotising fasciitis, with destruction of soft tissue, making reconstruction difficult. Antibiotic administration without removal of the cause is inadequate and can complicate subsequent management. We report the presentation and successful management of a 13-year-old boy, who developed necrotising fasciitis in the submandibular region as a result of inadequate initial treatment of a carious, lower molar resulting in significant skin and soft tissue loss.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Fasciitis, Necrotizing; Focal Infection, Dental; Humans; Male; Neck; Periapical Abscess; Streptococcal Infections

The growing resistance of Streptococcus pneumoniae to penicillin can be overcome by increasing the dose of the penicillin administered. This generated the recommendation that the adult dose of amoxicillin for the treatment of acute maxillary sinusitis (AMS) be increased from 1.5 g/day to 4.0 g/day. The objective of this study was to investigate whether the higher dose of amoxicillin is more effective than the previously recommended dose in eradicating S. pneumoniae from the nasopharynx of patients who present with AMS. Nasopharyngeal cultures obtained from 58 patients with AMS were studied: 30 received amoxicillin 1.5 g/day given in divided doses three times a day for 10 days (amoxicillin/clavulanic acid 4:1 formulation) and 28 were treated with amoxicillin 4.0 g/day given in divided doses twice a day for 10 days (amoxicillin/clavulanic acid 16:1 formulation). Seventy-one potentially pathogenic organisms were isolated: S. pneumoniae (27 isolates), Haemophilus influenzae non-type b (25), Moraxella catarrhalis (5), Streptococcus pyogenes (5) and Staphylococcus aureus (9). The number of S. pneumoniae isolates in the 1.5 g/day group was reduced from 14 to 9 (2 intermediately resistant and 3 highly resistant). In contrast, the number of S. pneumoniae isolates in the 4.0 g/day group was reduced from 13 to 2 (1 highly resistant) (P<0.05). No differences were noted in the eradication rate of other groups of isolates, which were all susceptible to amoxicillin/clavulanic acid. These data illustrate the superiority of 4.0 g/day amoxicillin/clavulanic acid compared with 1.5 g/day amoxicillin/clavulanic acid in the eradication of S. pneumoniae from the nasopharynx.

Topics: Acute Disease; Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Dose-Response Relationship, Drug; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Maxillary Sinusitis; Middle Aged; Moraxella catarrhalis; Moraxellaceae Infections; Nasopharynx; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Laparotomy; Peritonitis; Streptococcal Infections; Streptococcus pyogenes

The successful management of multi-space orofacial odontogenic infections involves identification of the source of the infection, the anatomical spaces encountered, the predominant microorganisms that are found during the various stages of odontogenic fascial space infection, the impact of the infectious process on defense systems, the ability to use and interpret laboratory data and imaging studies, and a thorough understanding of contemporary antibiotic and supportive care. The therapeutic goals, when managing multi-space odontogenic infections, are to restore form and/or function while limiting patient disability and preventing recurrence. Odontogenic infections are commonly the result of pericoronitis, carious teeth with pulpal exposure, periodontitis, or complications of dental procedures. The second and third molars are frequently the etiology of these multi-space odontogenic infections. Of the two teeth, the third molar is the more frequent source of infection. Diagnostic imaging modalities are selected based on the patient's history, clinical presentation, physical findings and laboratory results. Periapical and panoramic x-rays are reliable initial screening instruments used in determining etiology. Magnetic resonance imaging and computed tomography are ideal imaging studies that permit assessment of the soft tissue involvement to include determining fluid collections, distinguishing abscess from cellulitis, and offering insight as to airway patency. Antibiotics are administered to assist the host immune system's effort to control and eliminate invading microorganisms. Early infections, first three (3) days of symptoms, are primarily caused by aerobic streptococci which are sensitive to penicillin. Amoxicillin is classified as an extended spectrum penicillin. The addition of clavulanic acid to amoxicillin (Augmentin) increases the spectrum to staphylococcus and other anaerobes by conferring beta-lactamase resistance. In late infections, more than three (3) days of symptoms, the predominant microorganisms are anaerobes, predominantly Peptostreptococcus, Fusobacterium, or Bacteroides, that are resistant to penicillin. Clindamycin is an attractive alternative drug for first line therapy in the treatment of these infections. The addition of metronidazole to penicillin is also an excellent treatment choice. Alternatively, Unasyn (Ampicillin/Sublactam), should be considered. The mainstay of management of these infections remains appropriate culture for

Topics: Abscess; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Debridement; Diagnostic Imaging; Disease Progression; Drainage; Drug Therapy, Combination; Focal Infection, Dental; Gram-Positive Bacterial Infections; Humans; Male; Mandibular Diseases; Masticatory Muscles; Neck Muscles; Staphylococcal Infections; Staphylococcus epidermidis; Streptococcal Infections; Tooth Diseases

Laryngocele is an unusual laryngeal disease caused by an abnormal dilatation of the saccule of the laryngeal ventricule. Infection results in laryngopyocele. We report a case of laryngopyocele discovered in a patient presenting with fever, an inflammatory mass, dysphagia and minimal respiratory distress. Diagnosis was established from direct laryngoscopy and CT-scan. Early treatment consisted in antibiotics and needle aspiration followed by external excision. Laryngopyocele can sometimes be revealed by an episode of acute respiratory distress requiring tracheotomy. If there is no respiratory distress and if the infection is cured, endoscopic treatment with or without laser can be performed for internal laryngocele. The cervical approach can only be recommended for external or combined laryngocele.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drainage; Drug Therapy, Combination; Follow-Up Studies; Humans; Laryngeal Diseases; Male; Streptococcal Infections; Suppuration; Time Factors; Tomography, X-Ray Computed

Retropharyngeal cellulitis/abscess has not been recognized as a manifestation of group B streptococcal disease in the pediatric group beyond neonates. The purpose of this paper is to present a previously healthy 3-year-old boy with a retropharyngeal abscess due to group B Streptococcus which was successfully treated by surgical incision and drainage in combination with amoxicillin/clavulanate therapy.

Topics: Amoxicillin-Potassium Clavulanate Combination; Child, Preschool; Drainage; Drug Therapy, Combination; Humans; Male; Retropharyngeal Abscess; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Antibiotic prophylaxis in clean surgery with implantation of prosthetic material is widely accepted, although there are no studies on its use in abdominal incisional hernia repair. The objective was to evaluate antibiotic chemoprophylaxis in incisional herniorrhaphy with the implantation of prosthetic material. A prospective non-randomized study (1990-1998) was conducted to analyse 216 patients undergoing surgery for abdominal incisional hernia who required a prosthesis (polypropylene) in the reconstruction and who met the criteria for clean surgery. Risk factors were observed in 31.5%, the most frequent being diabetes and obesity. The incisional hernia was located mostly in the abdominal midline and in 64.4% measured over 10 cm. Antibiotic prophylaxis was administered in 140 patients (64.8%) via the systemic route, the antibiotics being first- or second-generation cephalosporins or amoxicillin-clavulanic acid. Surgical wound infection occurred in 39 patients (18.1%), 19 who had received antibiotic prophylaxis (13.6%) and 20 who had not (26.3%). In multivariate analysis using logistic regression, the variables with statistical significance for local septic infection were antibiotic prophylaxis and number of risk factors. We can conclude therefore that antibiotic chemoprophylaxis is useful in abdominal incisional herniorrhaphy surgery with implantation of prosthetic material for reducing local septic complications.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Drug Therapy, Combination; Female; Hernia, Ventral; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Prostheses and Implants; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Surgical Mesh; Surgical Wound Infection

Five years after a tooth extraction, a bone necrosis of the mandibular angle happened, without consideration to the antibiotics. Such complication is rare. Living in poor socio-cultural and economic conditions, the patient tried to find help near tradipractionners, prayers groups, without any result. The treatment consisted to an extra oral incision, helping to eliminate bone sequestra, and the liquid around after a dynamic bimaxillary linkage by resin links was settled. About aetiology, only the questioning allowed to say that extraction was traumatic, putting in front of the surgical responsibility and post surgical survey.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drug Therapy, Combination; Facial Asymmetry; Faith Healing; Female; Humans; Mandibular Diseases; Medicine, Traditional; Necrosis; Osteitis; Streptococcal Infections; Surgical Wound Infection; Tooth Extraction

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactam Resistance; Drug Administration Schedule; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Streptococcal Infections; Streptococcus pneumoniae

Topics: Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Drug Therapy, Combination; Humans; Male; Methylprednisolone; Middle Aged; Retropharyngeal Abscess; Streptococcal Infections; Streptococcus agalactiae

Topics: Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Liver Abscess; Streptococcal Infections; Sulbactam; Time Factors; Tomography, X-Ray Computed

Three patients with vulvovaginitis caused by Trichomonas vaginalis, which was refractory to conventional treatment with metronidazole are described. The T vaginalis strain isolated from one patient was resistant to metronidazole (minimum inhibitory concentration (MIC) more than 100 mg/l) under aerobic conditions, although under anaerobic conditions it was as susceptible as a normal reference strain. The effect of the concomitant use of other medication and the influence of other vaginal pathogens on the efficacy of metronidazole are highlighted.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Clinical Protocols; Drug Administration Schedule; Drug Combinations; Drug Resistance; Drug Therapy, Combination; Female; Humans; Metronidazole; Streptococcal Infections; Streptococcus agalactiae; Trichomonas vaginalis; Trichomonas Vaginitis

The response of Streptococcus pyogenes to amoxicillin or amoxicillin-clavulanic acid (Augmentin; Beecham Group) therapy of a mixed streptococcal-staphylococcal infection was studied in a surgical wound in mice. A superficial wound was produced on the backs of anesthetized mice, and a suture infected with S. pyogenes, Staphylococcus aureus, or a mixed inoculum of both organisms was inserted. Oral therapy was started 4 h after infection and continued for 3 days. Both amoxicillin and amoxicillin-clavulanic acid were effective in eliminating the streptococci from the pure wound infection. In contrast, amoxicillin failed to eliminate the streptococci from a mixed infection in which a beta-lactamase-producing strain of S. aureus was also present, wound counts reaching 10(7) streptococci per wound by 80 h, whereas amoxicillin-clavulanic acid reduced the count to less than 33 streptococci per wound by 24 h. Numbers of S. aureus were also reduced by amoxicillin-clavulanic acid therapy, controlling the infection, whereas amoxicillin was ineffective. Also of significance was the fact that successful therapy was achieved with blood and tissue concentrations of amoxicillin and clavulanic acid of the same order as those measured in humans. These results show that amoxicillin therapy failed to eliminate S. pyogenes from a wound infection in the presence of a beta-lactamase-producing strain of S. aureus and suggest the potential of amoxicillin-clavulanic acid in the treatment of mixed bacterial skin infections involving beta-lactamase-producing organisms.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Male; Mice; Microscopy, Electron, Scanning; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Wound Infection

Twenty patients, all admitted to hospital with acute purulent exacerbations of chronic bronchitis associated with Haemophilus influenzae, Streptococcus pneumoniae or beta-lactamase producing Branhamella catarrhalis were treated twice daily for ten days with amoxycillin/clavulanate. Ten patients were first given 1000 mg amoxycillin with 200 mg potassium clavulanate intravenously bd for three days, before crossing to the standard oral regimen of 1000 mg amoxycillin + 250 mg potassium clavulanate bd. Clinical results on day 10 were excellent in 16/20 patients, but 14 patients developed recurrences or reinfections within a week of the end-of-treatment, five of them with beta-lactamase producing B. catarrhalis. Bacteriological and kinetic studies showed that the branhamella beta-lactamases were inhibited by 0.25 mg/l clavulanic acid and that the mean sputum concentration of clavulanic acid was 0.16 mg/l, that of amoxycillin being 0.92 mg/l. The importance of the follow-up of such infections is stressed.

Topics: Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacterial Infections; beta-Lactamase Inhibitors; Bronchitis; Chronic Disease; Clavulanic Acids; Drug Combinations; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Kinetics; Male; Middle Aged; Moraxella; Recurrence; Sputum; Streptococcal Infections; Streptococcus pneumoniae