minocycline and Abscess

Treatment of uncomplicated skin and soft-tissue abscesses caused by meticillin-sensitive Staphylococcus aureus or meticillin-resistant S. aureus (MRSA) is problematic. Incision and drainage aside, oral antibiotic therapy for uncomplicated community-acquired MRSA (CA-MRSA) is limited and frequent choices include clindamycin, doxycycline or trimethoprim-sulfamethoxazole (TMP-SMX). The most common oral antibiotics used for CA-MRSA are doxycycline or TMP-SMX, which often fail to eradicate the infection. With MRSA, in vitro susceptibilities do not always predict in vivo effectiveness. In situations where doxycycline or TMP-SMX fails in the treatment of uncomplicated cutaneous abscesses due to CA-MRSA, minocycline is reliably effective.

Topics: Abscess; Administration, Oral; Anti-Bacterial Agents; Community-Acquired Infections; Doxycycline; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

We report two cases of primary cutaneous nocardiosis due to Nocardia otitidiscaviarum. The first case is a mycetoma, the second, a cutaneous abcess: these two cases were imported into France (Vietnam, Zimbabwe). The literature on primary cutaneous nocardiosis due to N. otitidiscaviarum is reviewed.

Topics: Abscess; Adult; Anti-Bacterial Agents; Cephalexin; Cephalosporins; Female; France; Gentamicins; Humans; Male; Middle Aged; Minocycline; Mycetoma; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Travel; Vietnam; Zimbabwe

A randomized, double-blind, multicenter trial was done to compare two doses of delafloxacin with tigecycline in patients with various complicated skin and skin-structure infections (wound infections following surgery, trauma, burns, or animal/insect bites, abscesses, and cellulitis).. Patients were randomized 1:1:1 to receive delafloxacin 300mg intravenous (IV) every 12h, delafloxacin 450mg IV every 12h, or tigecycline 100mg IV×1, followed by 50mg IV every 12h; randomization was stratified by infection type. Duration of therapy was 5-14 days. The primary efficacy analysis, performed on the clinically evaluable (CE) population at the test-of-cure (TOC) visit (14-21 days after the final dose of study drug), compared clinical response rates in the delafloxacin and tigecycline arms. Clinical response rates in the two delafloxacin arms were also compared.. Among CE patients, clinical cure rates at TOC visit were similar in the delafloxacin and tigecycline arms (94.3%, 92.5%, and 91.2%, respectively in delafloxacin 300-mg, delafloxacin 450-mg, and tigecycline arms). Overall, the most frequent adverse events were nausea, vomiting, and diarrhea; the 300-mg delafloxacin arm was the best-tolerated regimen.. Delafloxacin was similarly effective as tigecycline for a variety of complicated skin and skin-structure infections and was well tolerated. (Clinicaltrials.gov NCT 0719810).

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cellulitis; Double-Blind Method; Female; Fluoroquinolones; Humans; Male; Middle Aged; Minocycline; Tigecycline; Wound Infection; Young Adult

The patient was an 81-year-old man who visited a clinic for fever and lower abdominal pain. He was subsequently diagnosed with prostatitis based on computed tomography (CT) findings that showed swelling of the prostate. Despite treatment with antibacterial therapy, his symptoms did not improve significantly. Since the patient also had myelodysplastic syndrome, he was transferred to our hospital and subsequently diagnosed with prostate abscess based on findings on magnetic resonance imaging (MRI). The abscess had spread widely from the dorsal side of the trigone of the bladder to anterior wall of the rectum. Transperineal drainage was performed to preserve the urethral mucosa of the prostatic urethra. Considering the shape of the abscess cavity, one pigtail catheter was placed in the prostate and another was placed transperineally on the dorsal side of the trigone of the bladder. Cystostomy was performed at the same time. Culture of the abscess revealed the presence of Staphylococcus aureus. As there was little exudate from the abscess 9 days after drainage, the pigtail catheter on the dorsal side of the trigone of the bladder was removed following an injection of minocycline into the abscess. CT showed shrinkage of the abscess 4 days later, and the remaining intraprostatic pigtail catheter was removed after an injection of minocycline. The cystostomy pigtail catheter was subsequently removed since the patient was able to urinate smoothly after clamping. MRI confirmed the disappearance of the abscess cavity 2 months later.

Topics: Abscess; Aged, 80 and over; Drainage; Humans; Male; Minocycline; Prostate; Prostatic Diseases

Tigecycline is a broad-spectrum antibiotic that is indicated in the treatment of complicated intra-abdominal infections and complicated skin and skin and soft-tissue infections. We report the case of a 53-year old kidney transplant patient with a severe Mycobacterium abscess who developed life-threatening coagulopathy after initiation of tigecycline therapy. Further analysis revealed a severe hypofibrinogenemia. A few case reports previously described an association between tigecycline and prolongation of clotting time. Our case confirms an uncommon yet possibly life-threatening side-effect of tigecycline. Medical practitioners should be aware of this potential coagulopathy and we recommend routine monitoring of coagulation parameters in patients receiving tigecycline.

Topics: Abscess; Anti-Bacterial Agents; Humans; Middle Aged; Minocycline; Mycobacterium; Tigecycline

Topics: Abscess; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Lymphadenitis; Male; Middle Aged; Minocycline; Mycobacterium Infections, Nontuberculous; Rifampin; Skin Diseases, Bacterial

Topics: Abscess; Amikacin; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Azithromycin; Drug Resistance, Multiple, Bacterial; Hip Joint; Humans; Male; Middle Aged; Minocycline; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Skin Diseases, Bacterial; Tigecycline

We report the first case of Mycoplasma hominis periaortic abscess after heart-lung transplantation. The absence of sternal wound infection delayed the diagnosis, but the patient successfully recovered with debridement surgeries and long-term antibiotic therapy. Owing to the difficulty in detection and the intrinsic resistance to beta-lactams, M. hominis infections are prone to being misdiagnosed and undertreated. M. hominis should be suspected in cases where conventional microbiological identification and treatment approaches fail.

Topics: Abscess; Adult; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Bronchoscopy; Cardiomyopathy, Restrictive; Debridement; Dyspnea; Glucocorticoids; Graft Rejection; Heart-Lung Transplantation; Humans; Hypertension, Pulmonary; Levofloxacin; Male; Methylprednisolone; Minocycline; Mycoplasma hominis; Nausea; Plasmapheresis; Postoperative Complications; Respiratory Insufficiency; Sternum; Surgical Wound Infection; Tomography, X-Ray Computed; Young Adult

Methicillin-resistant Staphylococcus aureus (MRSA) producing Panton-Valentine leukocidin (PVL) is highly virulent. This study aimed to compare the efficacy of tigecycline versus vancomycin in experimental thigh abscess by a PVL-producing MRSA isolate. One hundred and ninety-six Wistar rats were divided into five groups: group A, controls; groups B and C, administered vancomycin starting 1 and 6 h after bacterial challenge respectively; groups D and E, administered tigecycline starting 1 and 6 h after bacterial challenge respectively. Treatment was continued every 12 hours for three consecutive days. Survival was recorded; separate animals were killed for quantitative cultures. Serum samples were collected for estimation of malondialdehyde (MDA). Survival of group D was prolonged compared to all other groups. The bacterial load of blood, liver, spleen and lung was significantly decreased within group D compared to group B at 36 hours. Treatment with tigecycline was accompanied by significant reduction of serum MDA at 24 hours. Tigecycline is comparable to vancomycin for the treatment of soft tissue infections by PVL-producing MRSA.

Topics: Abscess; Animals; Anti-Bacterial Agents; Bacterial Load; Bacterial Toxins; Drug Administration Schedule; Exotoxins; Immunocompromised Host; Injections, Intraperitoneal; Kaplan-Meier Estimate; Leukocidins; Lipid Peroxidation; Male; Methicillin-Resistant Staphylococcus aureus; Minocycline; Random Allocation; Rats, Wistar; Soft Tissue Infections; Staphylococcal Infections; Thigh; Tigecycline; Vancomycin; Virulence

Involvement of the renal parenchyma in the acute phase of brucellosis is very rare. Only two cases of renal brucelloma have been reported in the English language literature to date. We report a case of renal abscess caused by Brucella in the acute phase. A 45-year-old Chinese man presented with a high fever, urine occult blood, and a low density lesion in the right kidney. Ultrasound-guided aspiration was done. Brucella melitensis was isolated from both blood and puncture fluid culture. Minocycline combined with moxifloxacin was prescribed for 4 months. The infection relapsed at 6 months after discontinuation. Minocycline combined with rifampin was administered for another 2 months. The brucellosis had not relapsed at more than 20 months later. It is possible to cure renal brucelloma with antibiotics and ultrasound-guided aspiration. Treatment should not be discontinued until the abscess has disappeared and two consecutive blood cultures taken 1 month apart are negative.

Topics: Abscess; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Drug Therapy, Combination; Fluoroquinolones; Humans; Kidney Diseases; Male; Middle Aged; Minocycline; Moxifloxacin; Rifampin

Topics: Abscess; Adult; Anti-Bacterial Agents; Female; Humans; Minocycline; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Ofloxacin; Subcutaneous Tissue

Alkaptonuria, a rare autosomal-recessive disorder caused by mutations in the HGD gene and a deficiency of homogentisate 1,2-dioxygenase, is characterized by accumulation of homogentisic acid (HGA), ochronosis, and destruction of connective tissue resulting in joint disease. Certain medications have been reported to cause cutaneous hyperpigmentation resembling that of alkaptonuria. We present 5 such cases. Eighty-eight patients with a possible diagnosis of alkaptonuria were examined at the National Institutes of Health Clinical Center between June 2000 and March 2004. The diagnosis of alkaptonuria was confirmed or ruled out by measurement of HGA in the urine. Five patients with findings consistent with ochronosis, including pigmentary changes of the ear and mild degenerative disease of the spine and large joints, were diagnosed clinically as having alkaptonuria, but the diagnosis was withdrawn based on normal urine HGA levels. All 5 patients were women who had taken minocycline for dermatologic or rheumatologic disorders for extended periods. Minocycline-induced hyperpigmentation should be considered in the differential diagnosis of ochronosis. This could be of increased significance now that minocycline and other tetracyclines have been proposed as therapeutic options for rheumatoid arthritis, bringing a new population of patients with ochronosis and arthritis to medical attention with the potential, but incorrect, diagnosis of alkaptonuria.

Topics: Abscess; Acne Vulgaris; Adult; Aged; Alkaptonuria; Arthralgia; Arthritis, Rheumatoid; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Radiography

We report a patient with lepromatous leprosy who developed a rare variant of type-2 lepra reaction, characterized by pustular lesions, on switching from WHO multi drug therapy (MDT) to ofloxacin-aided MDT.

Topics: Abscess; Adult; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Macrophages; Male; Melanins; Minocycline; Mycobacterium tuberculosis; Neutrophils; Ofloxacin; Rifampin; Tumor Necrosis Factor-alpha; Vasculitis

We describe an unusual case of disseminated subcutaneous abscesses caused by Nocardia farcinica in a 49-year-old man with nephrotic syndrome. He had received systemic corticosteroid therapy for 5 months. He developed a submandibular abscess associated with sialoadenitis on the right submaxillary gland. Magnetic resonance imaging revealed connection between the submandibular abscess and the right submaxillary gland. The subcutaneous abscess spread from the submandibular triangle to the left axillary region, the left upper arm, the left hypochondriac region, the left scapular region, the right epigastric region, and the bilateral legs. A chest radiograph and computed tomograms of the chest and the brain did not reveal any pathologic changes. The patient was successfully treated by surgical drainage of the abscesses and by oral administration of minocycline.

Topics: Abdomen; Abscess; Anti-Bacterial Agents; Arm; Axilla; Drainage; Focal Infection; Humans; Leg; Magnetic Resonance Imaging; Male; Middle Aged; Minocycline; Nephrotic Syndrome; Nocardia; Nocardia Infections; Scapula; Shoulder; Skin Diseases, Bacterial; Submandibular Gland Diseases

Topics: Abscess; Aged; Anti-Bacterial Agents; Brain Abscess; Focal Infection; Humans; Immunocompetence; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Seizures; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Twenty-five patients had superficial ulcerative and vegetative pyoderma with granulomatous histologic findings. Healing occurred without systemic corticosteroid therapy in all but three patients. All patients had clinical pyoderma gangrenosum. In five patients the lesion occurred after surgery of the skin. Histopathologic study of 40 biopsy specimens showed focal neutrophilic abscesses of the papillary dermis, often with peripheral palisading histiocytes and foreign-body giant cells. Pseudoepitheliomatous, vegetative hyperplasia and sinus tract formation were observed frequently. All patient had massive areas of plasmacytosis, and 13 had eosinophils. Granulation tissue, hemorrhage, and fibrosis were additional features in some areas. Foreign material in the lesions was considered unimportant, except in one patient with a starch granuloma. Therapy with local corticosteroids, minocycline, tetracycline, or sulfa drugs resulted in healing in 15 patients. We believe that we have identified a localized, limited form of chronic superficial pyoderma gangrenosum with verrucous and ulcerative lesions and a granulomatous histologic appearance that represents a unique pattern of this disease in some patients.

Topics: Abscess; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Child; Female; Gangrene; Granuloma; Humans; Male; Middle Aged; Minocycline; Pyoderma; Skin Ulcer

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.

Topics: Abscess; Drug Combinations; Humans; Japan; Lymphoma; Male; Middle Aged; Minocycline; Nocardia Infections; Skin Diseases, Infectious; Sulfamethoxazole; T-Lymphocytes; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Induration of the lower parts of the legs with abscess and ulcer formation occurred in a 60-year-old woman. Mycobacterium chelonei, a ubiquitous, saprophytic pathogen that uncommonly causes human disease, was cultured from biopsy material. Although spontaneous healing usually occurs in a few months with such infections, our patient's disease persisted for more than two years until control was achieved with minocycline hydrochloride.

Topics: Abscess; Female; Humans; Leg Ulcer; Middle Aged; Minocycline; Mycobacterium; Mycobacterium Infections; Skin Diseases, Infectious

Two cases of Noca dia asteroides infection were encountered out of 55 kidney transplant patients at Chiba University Hospital. One patient developed an extrapleural abscess and the other had a pulmonary infiltration with chest wall abscess. The patients were successfully treated by surgical drainage of the chest wall abscesses and by oral administration of minocycline. No adverse effects caused by minocycline were observed during the therapy. From 1900, when the first case of Nocardia infection was reported in Japan, there have been 60 cases reported in Japanese literature through 1973, including those we observed. This is the first report on nocardiosis in kidney transplant patients and on successful treatment of nocardiosis with minocycline in Japan.

Topics: Abscess; Adult; Glomerulonephritis; Humans; Kidney Transplantation; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Pleural Effusion; Postoperative Complications; Tetracyclines; Transplantation, Homologous

To evaluate the management of colonic injuries, experimental models simulating acute injuries of the colon were studied utilizing New Zealand white rabbits. Seventy-nine rabbits underwent primary repair of colonic injuries in the presence of massive contamination and none showed any evidence of anastomotic leakage or breakdown. The fact that primary colonic repairs do heal even in the presence of infection suggests that breakdown of colonic anastomosis results from factors other than infection. Despite the absence of anastomotic leaks in this series, morbidity and mortality were high in those animals not given antibiotics. The high morbidity and mortality were due to peritonitis, intra-abdominal abscess, and wound infection, and were directly proportional to the length of time from colonic injury to repair. On the basis of this study, it is concluded that most isolated injuries of the colon can be closed primarily, if antibiotic therapy is begun immediately after injury and continued throughout the operative and postoperative periods.

Topics: Abscess; Animals; Anti-Bacterial Agents; Colon; Injections, Intraperitoneal; Injections, Intravenous; Minocycline; Peritonitis; Rabbits; Surgical Wound Dehiscence; Surgical Wound Infection; Therapeutic Irrigation; Time Factors; Wound Healing