rifampin and Paraplegia

Neural tube defects are the second most common congenital malformation in humans. Despite significant decreases in neural tube defects and related mortality and morbidity with recent developments, infections remain an important problem. Research on the role of topical therapy for managing neural tube defects and associated infections in the neonatal period has been limited. This randomized controlled trial aimed to investigate the efficiency of topical Rifampin on infection control in paraplegic newborns with open neural tube defects.. Thirty-seven patients who underwent an operation for neural tube defects were included. Topical Rifampin and cefotaxime were administered to 19 patients constituting the case group and local saline and cefotaxime were administered to a control group. Patients were examined for ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, and sepsis.. None of the patients using topical rifampin had ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, or sepsis. In the control group, ventriculoperitoneal shunt infection/dysfunction was found in 4 (22.2%) cases, surgical site infection in 3 (27.7%), urinary tract infection in 3 (27.7%), and sepsis in 5 (27.7%), with statistically significant differences between the groups (. Topical Rifampin is effective in minimizing complications like sepsis, surgical site infection, urinary tract infection, and ventriculoperitoneal shunt infection due to neural tube defect operations. Further research with larger numbers of cases is needed to implement this practice routinely.

Topics: Administration, Topical; Anti-Bacterial Agents; Catheter-Related Infections; Cefotaxime; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Neural Tube Defects; Paraplegia; Rifampin; Sepsis; Surgical Wound Infection; Treatment Outcome; Urinary Tract Infections; Ventriculoperitoneal Shunt

The final results up to 15 years are reported of clinical trials of the management of tuberculosis of the spine in Korea and Hong Kong. In Korea, 350 patients with active spinal tuberculosis were randomised to ambulatory chemotherapy or bed rest in hospital (in Masan) or a plaster-of-Paris jacket for nine months (in Pusan). Patients in both centres were also randomised to either PAS plus isoniazid for 18 months or to the same drugs plus streptomycin for the first three months. In Hong Kong, all 150 patients were treated with the three-drug regime and randomised to either radical excision of the spinal lesion with bone graft or open debridement. On average, the disease was more extensive in Korea, but at 15 years (or 13 or 14 years in a proportion of the patients in Korea) the great majority of patients in both countries achieved a favourable status, no evidence of CNS involvement, no radiological evidence of disease, no sinus or clinically evident abscess, and no restriction of normal physical activity. Most patients had already achieved a favourable status much earlier. The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset paraplegia. The results of chemotherapy on an outpatient basis were not improved by bed rest or a plaster jacket and the only advantage of the radical operation was less late deformity compared with debridement. A second series of studies has shown that short-course regimes based on isoniazid and rifampicin are as effective as the 18-month regimes: ambulatory chemotherapy with these regimes should now be the main management of uncomplicated spinal tuberculosis.

Topics: Adolescent; Adult; Ambulatory Care; Aminosalicylic Acid; Antibiotics, Antitubercular; Antitubercular Agents; Bed Rest; Bone Transplantation; Casts, Surgical; Child; Child, Preschool; Combined Modality Therapy; Debridement; Female; Follow-Up Studies; Hong Kong; Hospitalization; Humans; Infant; Isoniazid; Korea; Longitudinal Studies; Male; Middle Aged; Paraplegia; Randomized Controlled Trials as Topic; Rifampin; Spinal Diseases; Streptomycin; Treatment Outcome; Tuberculosis, Spinal

Topics: Adult; Antitubercular Agents; Cervical Vertebrae; Diagnosis, Differential; Female; Humans; Infant, Newborn; Isoniazid; Magnetic Resonance Imaging; Paraplegia; Pregnancy; Pregnancy Complications, Infectious; Pyrazinamide; Pyridoxine; Rifampin; Tuberculosis, Spinal

To report our therapeutic experience with tuberculosis of the lower cervical spine with neurological complications in 9 adults in Gabon.. A retrospective study of these 9 adults treated for progressive Pott's tetraplegia or paraplegia from 1982 to 1998 was conducted. The medical treatment consisted of the early administration in the first 3 patients of rifampin, isoniazid and ethambutol for 18 months; and, in the remaining 6 patients, of rifampin, isoniazid, ethambutol and pyrazinamide for 6 months. This medical treatment was systematically started 3 weeks before surgery in 7 patients, once the disease had been diagnosed radiologically. Two patients with an acute onset of paraplegia underwent surgery on an emergency basis. The standard anterior approach was used: debridement was done in 3 cases, to establish the diagnosis; 6 patients underwent radical surgery for severe neurological deficit and spinal instability. Average follow-up time was 40.6 months.. Three patients were found to be functionally and neurologically normal at follow-up examinations. Eight of the nine patients recovered sufficiently to walk unaided. One patient was able to get about on crutches. After 3-4 months, a satisfactory consolidation was already observed, with reduction of kyphosis in 4 cases. All patients were considered medically cured by the Antituberculous Center.. Early radical surgery, as primary procedure, in conjunction with a six-month chemotherapeutic regimen (four drugs) seems to be adequate for the management of tuberculosis of the lower cervical spine with neurological complications and spinal instability, in our setting.

Topics: Adult; Antitubercular Agents; Cervical Vertebrae; Combined Modality Therapy; Debridement; Emergencies; Ethambutol; Follow-Up Studies; Gabon; Humans; Isoniazid; Kyphosis; Paraplegia; Physical Therapy Modalities; Pyrazinamide; Quadriplegia; Retrospective Studies; Rifampin; Treatment Outcome; Tuberculosis, Spinal

Topics: Adolescent; Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Cerebrospinal Fluid; Diplopia; Headache; Humans; Male; Paraplegia; Polyradiculoneuropathy; Prednisone; Rifampin; Rose Bengal

A 20-year-old male Turkish immigrant to Norway suffering from severe chronic neurobrucellosis with spastic paraplegia and deafness is presented. The diagnosis was established by isolation of Brucella melitensis from cerebrospinal fluid (CSF) culture. Brucella antibody agglutination titers were high in serum and CSF. In spite of intensive, prolonged treatment with a combination of trimethoprim-sulfamethoxazole (TPM-SMZ), rifampicin and doxycycline, the course of the illness was characterized by relapses and severe neurological defects.

Topics: Adult; Agglutination; Brucellosis; Deafness; Humans; Male; Paraplegia; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Experience gained in the management of 261 patients with tuberculous paraplegia and paraparesis seen over a 17-year period is presented. A plea is made for prompt spinal canal decompression in all cases of tuberculosis of the spine with evidence of neurological involvement.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Isoniazid; Male; Middle Aged; Paraplegia; Pyrazinamide; Rifampin; Spinal Canal; Spinal Fusion; Streptomycin; Tuberculosis, Spinal

Topics: Abscess; Ethambutol; Humans; Intervertebral Disc; Isoniazid; Paraplegia; Rifampin; Spinal Fusion; Tuberculosis, Spinal