rifampin and Diabetes-Mellitus--Type-1

The objective of this study was to compare prophylaxis for Staphylococcus aureus infections in peritoneal dialysis patients using 600 mg cyclic oral rifampin for 5 days every 3 months versus mupirocin calcium ointment 2% applied daily to the exit site. The study design was a prospective randomized trial, controlling for S aureus nasal carriage. Eighty-two continuous ambulatory and continuous cyclic peritoneal dialysis patients (54% male, 71 % white, 34% insulin-dependent, mean prestudy time on peritoneal dialysis 1.2 years) were randomly assigned to cyclic rifampin (n = 41 patients) or daily exit site mupirocin prophylaxis (n = 41 patients). Mean follow-up was 1 year. S aureus catheter infection rates were 0.13/yr with mupirocin and 0.15/yr with rifampin (P = NS). Both rates were significantly lower than the center's historical rate (the period between 1983 and 1992) of 0.46/yr prior to the study (P < 0.001). S aureus peritonitis rates were 0.04/yr with mupirocin and 0.02/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.16/yr (P < 0.02). Catheter loss due to S aureus infections was 0.02/yr with mupirocin and 0/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.12/yr (P < 0.001). There were no side effects in patients using mupirocin, but 12% were unable to continue rifampin due to side effects. We conclude that mupirocin ointment at the exit site and cyclic oral rifampin are equally effective in reducing S aureus catheter infections. In addition, rifampin or mupirocin significantly reduced S aureus peritonitis and catheter loss due to S aureus infections. Mupirocin at the exit site provides an excellent alternative prophylaxis for S aureus infections, particularly in patients who cannot tolerate oral rifampin therapy.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Catheters, Indwelling; Chemoprevention; Diabetes Mellitus, Type 1; Drug Administration Schedule; Equipment Contamination; Equipment Failure; Female; Follow-Up Studies; Humans; Male; Mupirocin; Nose; Ointments; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus

The case is presented of a 29-year-old woman who complained of headache over a period of several days, with loss of visual acuity and pain in her left eye. She had a 3-year history of type 1 diabetes mellitus, and was an immigrant from Ecuador. The funduscopic examination revealed a papilledema. The polymerase chain reaction (PCR) study of the cerebrospinal fluid was positive for Mycobacterium tuberculosis (MTB). She showed a marked improvement after treatment with anti-TB drugs.. About a third of the world's population has a latent infection of MTB, comorbidity between diabetes mellitus and tuberculosis has been reported, particularly in undeveloped countries.

Topics: Adult; Antitubercular Agents; Atrophy; Cerebrospinal Fluid; Developing Countries; Diabetes Mellitus, Type 1; Drug Therapy, Combination; Ecuador; False Negative Reactions; Female; Humans; Immunocompromised Host; Isoniazid; Latent Tuberculosis; Mycobacterium tuberculosis; Ophthalmoscopy; Optic Nerve; Papilledema; Rifampin; Spinal Puncture; Tuberculin Test; Tuberculosis, Meningeal

Intensive chemotherapy for first detected pulmonary tuberculosis was initiated in 110 patients with diabetes mellitus (DM). Types 1 and 2 DM was present in 52 and 58 patients, respectively. In accordance with the WHO recommendations, isoniazid, rifampicin, pyrazinamide, and streptomycin or ethambutol were given to the patients at the first loading stage. Following 2-3 months, they were treated with isoniazid and rifampicin (as well as with pyrazinamide in some cases). A good or fair tolerability of the first stage of chemotherapy was noted in 86 (78.2%) patients with concurrent pathology (Group 1). The signs of intolerability developed in the remaining 24 (21.8%) patients forced them have an individually chosen chemotherapy regime instead of the standard one (Group 2). Both groups were comparable by age, gender, the pattern of a pulmonary process, the types and severity of DM. The effect of treatment was much higher in Group 1 patients. According to the data of bacterioscopy and inoculation, bacterial isolation ceased in them earlier and achieved more frequently than in Group 2 patients (83.7 and 54.5%, respectively; p < 0.05). Better X-ray lung changes were revealed after 4-month therapy. Decay cavity closure after 10 months of treatment was achieved in 69.3 and 30% of the patients in Groups 1 and 2, respectively (p < 0.05). Thus, most patients with DM tolerated intensive chemotherapy for pulmonary tuberculosis well or satisfactorily. The higher efficiency of this therapy than that of individually selected regiment allows the author recommend its wider use in patients with this concomitant pathology.

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Data Interpretation, Statistical; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Pyrazinamide; Radiography, Thoracic; Rifampin; Time Factors; Tuberculosis, Pulmonary

Diabetes mellitus accompanying tuberculosis complicates the course of the latter and remains a topical problem of phthisiology. Surgical treatment of patient with both conditions presents a high risk and is employed unreasonably rarely. The results of medical (173 patients) and surgical (107 patients) treatments were studied in patients with destructive tuberculosis concurrent with diabetes mellitus. Analyzing early and late results of treatment showed a more steady-state effect in the group of surgically treated patients. Thus, surgery should be desirably used in all patients with preserving destructive changes after the basic course of antibacterial therapy.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Diabetes Complications; Diabetes Mellitus, Type 1; Female; Follow-Up Studies; Humans; Isoniazid; Male; Middle Aged; Pneumonectomy; Rifampin; Risk Factors; Thoracoplasty; Time Factors; Tuberculoma; Tuberculosis, Pulmonary

Topics: Aged; Cell Count; China; Clofazimine; Dapsone; Diabetes Mellitus, Type 1; Emigration and Immigration; Female; Hawaii; Humans; Leprosy; Mycobacterium leprae; Rifampin; United States

Topics: Anti-Bacterial Agents; Diabetes Mellitus, Type 1; Erythromycin; Fasciitis, Necrotizing; Fatal Outcome; Female; Fluorescent Antibody Technique, Indirect; Humans; Kidney Transplantation; Legionella; Legionnaires' Disease; Middle Aged; Pancreas Transplantation; Rifampin; Travel

We hereby describe a patient in whom chronic rifampicin treatment led to a misdiagnosis of Cushing's syndrome. He had long-standing insulin-dependent diabetes mellitus and active tuberculosis resistant to conventional treatment. The course was complicated by muscle weakness, lower limb atrophy, unstable glycemic control and hypokalemia. Ectopic Cushing's syndrome was suspected on the basis of high urinary free cortisol excretion (UFC) with a blunted circadian profile of serum cortisol and measurable plasma ACTH concentrations. Dynamic endocrine tests and imaging studies were compatible with occult ectopic ACTH syndrome. After substitution of rifampicin UFC excretion returned to normal within two weeks, as well as the 24-h cortisol profile and dynamic tests. The present case provides a practical example of the possibility to incorrectly suspecting Cushing's syndrome in patients treated with rifampicin, as previously envisaged by pharmacological studies.

Topics: Adrenocorticotropic Hormone; Adult; Corticotropin-Releasing Hormone; Cushing Syndrome; Diabetes Mellitus, Type 1; Diagnostic Errors; Humans; Hydrocortisone; Male; Metyrapone; Rifampin; Tuberculosis, Pulmonary

Topics: Blood Glucose; Diabetes Mellitus, Type 1; Drug Therapy, Combination; Female; Humans; Insulin; Isoniazid; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

To increase awareness of adverse events associated with the use of implantable insulin pumps.. A descriptive case report of a pump implant infection.. This is a case report of one implanted insulin pump-pocket infection among a series of 15 patients. After exposure to a child with a respiratory infection on PID 30, V.L.C. (the patient) developed a fulminant pump-pocket infection. H. influenza was recovered from it. Despite aggressive antibiotic therapy, the infection could not be controlled. Insulin delivery ceased, and the pump was explanted. The pump-pocket infection rapidly resolved with pump removal, permitting later reimplantation.. We have adopted the American Heart Association indications and antimicrobial prophylaxis regimens recommended for prevention of endocarditis in patients with prosthetic values for patients with implanted insulin pumps.

Topics: Adult; Ampicillin; Diabetes Mellitus, Type 1; Drug Therapy, Combination; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Insulin Infusion Systems; Rifampin; Sulbactam