rifampin and Respiratory-Tract-Infections

We describe two cases of pulmonary infection due to Mycobacterium xenopi (M. xenopi). Both cases were men, ages 61 and 54 yr. In the first patient, lung infection due to M. xenopi occurred after gastrectomy. The second patient had an inactive M. tuberculosis infection. Both had pulmonary symptoms including cough, sputum and fever. Each chest X-ray showed an infiltrative shadow with a cavity in a unilateral, upper lobe. Isolates from both patients were studied not only by microbiological characteristics but also by DNA-DNA hybridization. All isolates were susceptible to streptomycin and kanamycin. In the first case, the patient had initially received rifampicin, isoniazid and ethambutol despite in vitro susceptibility patterns, however, there was no response and a new infiltrative shadow appeared in the contralateral lobe. With a multiple drug regimen based on in vitro susceptibility, clinical and roentgenographic improvements were achieved. The second patient showed a favorable response to the initial chemotherapy. Pulmonary infection due to M. xenopi can generally be successfully treated with drugs to which the organisms show in vitro sensitivity. We also reviewed the other two cases reported in Japan.

Topics: Bacterial Typing Techniques; Clarithromycin; Cycloserine; DNA Probes; Drug Resistance, Microbial; Gastrectomy; Humans; Isoniazid; Kanamycin; Male; Middle Aged; Mycobacterium Infections; Respiratory Tract Infections; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Bacterial Infections; Cattle; Cattle Diseases; Chloramphenicol; Erythromycin; Female; Horse Diseases; Horses; Kinetics; Oxytetracycline; Penicillins; Respiratory Tract Infections; Rifampin

Topics: Adult; Aged; Amantadine; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Cephalosporins; Cyclophosphamide; Drug Combinations; Erythromycin; Ethambutol; Humans; Metronidazole; Pyrazinamide; Respiratory Tract Diseases; Respiratory Tract Infections; Rifampin; Trimethoprim; Tuberculosis, Pulmonary

The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.

Topics: Amphotericin B; Cephalosporins; Chloramphenicol; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Lincomycin; Mycoses; Nalidixic Acid; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Sulfamethoxazole; Tetracyclines; Trimethoprim; Urinary Tract Infections; Vancomycin

Topics: Amantadine; Anti-Inflammatory Agents; Antimetabolites; Antiviral Agents; Chemical Phenomena; Chemistry; Herpesviridae Infections; Humans; Idoxuridine; Immunosuppression Therapy; Influenza, Human; Interferons; Isoquinolines; Oxolinic Acid; Respiratory Tract Infections; Rifampin; Smallpox; Thiosemicarbazones; Virus Diseases

Topics: Amantadine; Anti-Bacterial Agents; Antiviral Agents; Binding Sites; Gastroenteritis; Herpesviridae Infections; Humans; Idoxuridine; Influenza, Human; Interferons; Poxviridae Infections; Respiratory Tract Infections; Rifampin; Steroids; Thiosemicarbazones; Virus Diseases; Virus Replication

Topics: Abnormalities, Drug-Induced; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Chemical and Drug Induced Liver Injury; Drug Interactions; Drug Resistance, Microbial; Endocarditis, Bacterial; Gonorrhea; Humans; Intestinal Absorption; Leprosy; Meningococcal Infections; Mycobacterium; Respiratory Tract Infections; Rifampin; Thrombocytosis; Tuberculosis; Tuberculosis, Pulmonary; Urologic Diseases; Viruses

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antitubercular Agents; Bronchitis; Drug Resistance, Microbial; Drug Synergism; Ethambutol; Humans; Microbial Sensitivity Tests; Pneumonia; Respiratory Tract Infections; Rifampin; Tuberculosis, Pulmonary

Topics: Acute Disease; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Aerosols; Asthma; Bronchitis; Chromones; Chronic Disease; Ethambutol; Humans; Mycoplasma Infections; Respiratory Insufficiency; Respiratory Tract Diseases; Respiratory Tract Infections; Rifampin; Tuberculosis; Tuberculosis, Pulmonary; Virus Diseases

Topics: Adult; Anti-Bacterial Agents; Cephaloridine; Enterobacteriaceae Infections; Fusidic Acid; Gentamicins; Humans; Infant; Infections; Lincomycin; Nalidixic Acid; Penicillin Resistance; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Sulfamethoxazole; Tuberculosis; Urinary Tract Infections

Clarithromycin (CLA) is a well established macrolide antibiotic which is frequently used in therapy of airway diseases in foals. It is extensively metabolized by CYP3A4 resulting in the antimicrobial active metabolite 14-hydroxyclarithromycin (OH-CLA). Rifampicin (RIF) is often comedicated to prevent resistance and augment therapy. RIF is a known inducer for metabolizing enzymes and transporter proteins. Therefore, comedication might bare the risks of pharmacokinetic drug interactions which were investigated in a clinical trial. As no adequate method to determine CLA, RIF and their main metabolites OH-CLA and 25-O-desacetylrifampicin (DAc-RIF) were described so far, we developed a selective and sensitive assay to measure concentrations of all four substances simultaneously in plasma, epithelial lining fluid (ELF) and broncho-alveolar cells (BAC) of foals. Drugs were measured after extraction with methyl tert-butyl ether using roxithromycin as internal standard and liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) for detection. The chromatography was done isocratically using 25mM ammonium acetate buffer (pH 4)/acetonitrile (45%/55%, flow rate 200μl/min). The MS/MS analysis was performed in the positive ion mode (m/z transitions: CLA, 748.5-590.1; OH-CLA, 764.1-606.1; RIF, 823.1-791.2; DAc-RIF, 781.1-749.1 and 837.3-679.2 for the internal standard). The method was validated according to selectivity, linearity, accuracy, precision, recovery, matrix effects and stability. The validation ranges for all substances were 2.5-25 for the low and 25-250ng/ml for the high validation range. The described assay was shown to be valid and successfully applied to measure disposition of CLA, OH-CLA, RIF and DAc-RIF in plasma, ELF and BAC of foals in a clinical trial.

Topics: Animals; Anti-Bacterial Agents; Biotransformation; Bronchioles; Bronchoalveolar Lavage Fluid; Chromatography, High Pressure Liquid; Clarithromycin; Drug Interactions; Drug Stability; Horse Diseases; Horses; Limit of Detection; Pulmonary Alveoli; Reproducibility of Results; Respiratory Tract Infections; Rifampin; Spectrometry, Mass, Electrospray Ionization; Tandem Mass Spectrometry

In this study the results of treatment of 37 patients with non-tuberculous mycobacterial disease were analyzed. The responsible strains were indentified as M. kansasi in 16 patients, M. avium-intracellulare in 10 patients, M. avium intracellulare and M. xenopi in 3 patients, M. xenopi and M. chalone in 7 patients. Patients with M. kansasi infection had been treated for 12 months. Sputum culture became negative in all patients after 2 months of treatment mainly with ryfamipcin (R) and etambutol (E). Thirteen patients infected with M. avium-intracellulare or M. avium-intracellulare and M. xenopi had been treated for 24 months according to the drug sensitivity tests. Sputum conversion was achieved only in 4 out of 11 patients. In 3 patients sputum examination was positive inspite for the regression of chest X-ray lesions. In 2 cases despite the resistance in vitro to all drugs, during treatment with H, R, E and aminoglicoside-sputum culture become negative. Four patients died due to the progression of non-tuberculous mycobacterial infection. In a group of 7 patients infected with M. xenopi sputum--negative results were observed after 2 months of treatment. One patient infected with M. chaelone had been treated for 6 months with clarithromycine, and sputum culture become negative after 2 months of the treatment.

Topics: Adult; Aged; Antitubercular Agents; Drug Resistance; Drug Therapy, Combination; Ethambutol; Female; HIV Seronegativity; Humans; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Respiratory Tract Infections; Retrospective Studies; Rifampin; Sputum; Treatment Outcome

Topics: Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Respiratory Tract Infections; Rifampin

Topics: Adult; Aged; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Rifampin

Clinical management of macrolide-resistant Mycobacterium avium complex (MR-MAC) lung disease is difficult. To date, there only exist a limited number of reports on the treatment of clarithromycin-resistant MAC (CR-MAC) lung disease. This study aimed to evaluate prognostic factors and identify effective treatments in CR-MAC lung disease. We retrospectively collected clinical data of patients newly diagnosed with CR-MAC lung disease at the Kinki-Chuo Chest Medical Center between August 2010 and June 2018. Altogether, 37 patients with CR-MAC lung disease were enrolled. The median age was 69 years; 30, 22, and 21 patients received clarithromycin, ethambutol, and rifampicin, respectively, on their own or in drug combination. The observed sputum culture conversion rate was 29.7% (11/37 patients). In univariate analysis, ethambutol significantly increased the rate of sputum culture conversion (p = 0.027, odds ratio (OR) 10; 95% confidence interval (CI) 1.11-89.77). Multivariate analysis confirmed that ethambutol increased sputum culture conversion rate (p = 0.026; OR 21.8; 95% CI 1.45-329) while the existence of lung cavities decreased it (p = 0.04; OR 0.088; 95% CI 0.009-0.887). The combined use of ethambutol with other drugs may improve sputum culture conversion rate in CR-MAC lung disease.

Topics: Aged; Antitubercular Agents; Clarithromycin; Drug Resistance, Bacterial; Drug Therapy, Combination; Ethambutol; Female; Humans; Japan; Lung; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prognosis; Respiratory Tract Infections; Retrospective Studies; Rifampin; Sputum; Tomography, X-Ray Computed; Treatment Outcome

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.

Topics: Anti-Bacterial Agents; Bronchopulmonary Dysplasia; Developmental Disabilities; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Male; Methylprednisolone; Penicillins; Respiration, Artificial; Respiratory Tract Infections; Rifampin; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

High dose delivery of drugs to the lung using a dry powder inhaler (DPI) is an emerging approach to combat drug-resistant local infections. To achieve this, highly aerosolizable powders are required. We hypothesized that co-spray-drying kanamycin, a hydrophilic hygroscopic antibiotic, with rifampicin, a hydrophobic antibiotic, would produce inhalable particles with surfaces enriched in rifampicin. Such particles would have higher aerosolization than kanamycin alone, and minimise the mass of powder for inhalation avoiding use of non-active excipients. Kanamycin was co-spray-dried with rifampicin using a Buchi Mini Spray-dryer. All powders were inhalable in size (1.1-5.9 µm) and noncrystalline. X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) showed the surface of the combination powder was enriched with rifampicin. In vitro aerosolization (fine particle fraction) determined by next generation impactor (NGI), dramatically improved from 29.5 ± 0.2% (kanamycin-only) to 78.2 ± 1.3% (kanamycin-rifampicin combination). The combination powder was flake-shaped in morphology, stable at 15% and 53% RH and 25 ± 2 °C during one-month storage in an open Petri dish, and non-toxic (up to 50 µg/mL) to human alveolar and bronchial cell-lines. Surface enrichment of kanamycin by hydrophobic rifampicin improves aerosolization, which may help to combat drug-resistant local infections by facilitating high dose delivery to deep lung.

Topics: Administration, Inhalation; Aerosols; Anti-Bacterial Agents; Chemistry, Pharmaceutical; Desiccation; Drug Combinations; Drug Compounding; Dry Powder Inhalers; Humans; Hydrophobic and Hydrophilic Interactions; Kanamycin; Particle Size; Powders; Respiratory Tract Infections; Rifampin; Surface Properties; Wettability

Pulmonary infection due to Mycobacterium malmoense can be difficult to diagnose. These difficulties can be responsible for a delay in the implementation of optimal treatment. Moreover, the treatment is not standardized.. We report the case of a 56-year-old patient who developed a Mycobacterium malmoense pulmonary infection whose diagnosis was delayed due to initial suspicion of pulmonary Mycobacterium tuberculosis infection. Once the diagnosis was confirmed, the patient was treated empirically with rifampicin, ethambutol, and clarithromycin for 12 months after culture conversion, giving a total of 15 months. The clinical and radiological outcomes were favorable.. This clinical case highlights the difficulties of diagnosing pulmonary atypical mycobacterial infection according to the American Thoracic Society criteria, particularly Mycobacterium malmoense, a non-tuberculous mycobacterium (NTM) quite uncommon in France. Currently, there are new diagnostic techniques such as GenoType Mycobacteria Direct. A more systematic reporting strategy could allow cohort studies and therefore provide us with data on the most efficient drugs in the treatment of the rarest NTM infections.

Topics: Clarithromycin; Diagnosis, Differential; Ethambutol; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Respiratory Tract Infections; Rifampin; Tuberculosis, Pulmonary

Colistin is often the only effective antibiotic against the respiratory infections caused by multidrug-resistant Gram-negative bacteria. However, colistin-resistant multidrug-resistant isolates have been increasingly reported and combination therapy is preferred to combat resistance. In this study, five combination formulations containing colistin (COL) and rifampicin (RIF) were prepared by spray drying. The lowest minimum inhibitory concentration (MIC) value against Pseudomonas aeruginosa PAO1 was measured for the formulation of COL/RIF = 4:1 with relatively high emitted doses (over 80%) and satisfactory fine particle fractions (over 60%). Data from X-ray photoelectron spectroscopy (XPS) and nano-time-of-flight secondary ion mass spectrometry (ToF-SIMS) showed the surfaces of particles were mainly covered by rifampicin even for the formulation with a mass ratio of COL/RIF = 4:1. Because colistin is hygroscopic and rifampicin is hydrophobic, moisture absorption of combination formulations was significantly lower than the pure colistin formulation in the dynamic vapour sorption results. To investigate the dissolution characteristics, four dissolution test methods (diffusion Franz cell, modified Franz cell, flow-through and beaker methods) were employed and compared. The modified Franz cell method was selected to test the dissolution behaviour of aerosolised powder formulations to eliminate the effect of membrane on dissolution. The results showed that surface enrichment of hydrophobic rifampicin neither affected aerosolisation nor retarded dissolution rate of colistin in the combination formulations. For the first time, advanced surface characterisation techniques of XPS and ToF-SIMS have shown their capability to understand the effect of surface composition on the aerosolisation and dissolution of combination powders.

Topics: Administration, Inhalation; Aerosols; Anti-Bacterial Agents; Colistin; Dry Powder Inhalers; Microbial Sensitivity Tests; Particle Size; Pseudomonas aeruginosa; Respiratory Tract Infections; Rifampin; Solubility; Surface Properties

Colistin has been increasingly used for the treatment of respiratory infections caused by Gram-negative bacteria. Unfortunately parenteral administration of colistin can cause severe adverse effects. This study aimed to develop an inhaled combination dry powder formulation of colistin and rifapentine for the treatment of respiratory infections. The combination formulation was produced by spray-drying rifapentine particles suspended in an aqueous colistin solution. The combination dry powder had enhanced antimicrobial activities against planktonic cells and biofilm cultures of Pseudomonas aeruginosa, with both minimum inhibitory concentration (MIC) and minimum biofilm inhibitory concentration (MBIC) values (2 and 4 mg/L, respectively) being half that of pure colistin (MIC 4 mg/L and MBIC 8 mg/L) and 1/16th that of pure rifapentine (MIC 32 mg/L and MBIC 64 mg/L). High aerosol performance, as measured via an Aerolizer device, was observed with emitted doses>89% and fine particle fraction (FPF) total>76%. The proportion of submicron particles of rifapentine particles was minimized by the attachment of colistin, which increased the overall particle mass and aerodynamic size distribution. Using the spray-drying method described here, stable particles of amorphous colistin and crystalline rifapentine were distributed homogeneously in each stage of the impinger. Unlike the colistin alone formulation, no deterioration in aerosol performance was found for the combination powder when exposed to a high relative humidity of 75%. In our previous study, surface coating by rifampicin contributed to the moisture protection of colistin. Here, a novel approach with a new mechanism was proposed whereby moisture protection was attributed to the carrier effect of elongated crystalline rifapentine particles, which minimized contact between hygroscopic colistin particles. This inhaled combination antibiotic formulation with enhanced aerosol dispersion efficiency and in vitro efficacy could become a superior treatment for respiratory infections.

Topics: Administration, Inhalation; Anti-Infective Agents; Biofilms; Colistin; Drug Combinations; Drug Synergism; Dry Powder Inhalers; Humans; Microbial Sensitivity Tests; Nanoparticles; Nasal Sprays; Particle Size; Plankton; Powders; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Tract Infections; Rifampin

The prevalence of MRSA in patients with CF is increasing. There is no consensus as to the optimum treatment.. An observational cohort study of all patients with MRSA positive sputum, 2007-2012. All eradication attempts with subsequent culture results were reviewed. Single vs dual antibiotic regimens were compared for both new and chronic infections.. 37 patients (median FEV1 58.7 (27.6-111.5)% predicted) were identified, of which 67.6% (n = 25) had newly acquired MRSA. Compared with single regimens, a high proportion of dual regimens achieved MRSA eradication (84.6% vs 50%; p = 0.1) for new infections. Rifampicin/Fusidic acid was associated with high success rates (100% vs 60% for other dual regimens (p = 0.13)). Compared with new infections, chronic MRSA was much less likely to be eradicated (18.2%, p = 0.01).. Combined antibiotic therapy, particularly Rifampicin/Fusidic acid, is a well-tolerated and effective means of eradicating MRSA in patients with cystic fibrosis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Body Mass Index; Cystic Fibrosis; Disease Eradication; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Outpatient Clinics, Hospital; Pneumonia, Staphylococcal; Prevalence; Respiratory Tract Infections; Retrospective Studies; Rifampin; Treatment Outcome; United Kingdom

Topics: Antibiotics, Antitubercular; Drug Resistance, Bacterial; Female; Humans; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Respiratory Tract Infections; Rifampin; Tuberculosis; Tuberculosis, Pulmonary

Topics: Antibiotics, Antitubercular; Drug Resistance, Bacterial; Female; Humans; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Respiratory Tract Infections; Rifampin; Tuberculosis; Tuberculosis, Pulmonary

Respiratory anthrax is a fatal disease in the absence of early treatment with antibiotics. Rabbits are highly susceptible to infection with Bacillus anthracis spores by intranasal instillation, succumbing within 2 to 4 days postinfection. This study aims to test the efficiency of antibiotic therapy to treat systemic anthrax in this relevant animal model. Delaying the initiation of antibiotic administration to more than 24 h postinfection resulted in animals with systemic anthrax in various degrees of bacteremia and toxemia. As the onset of symptoms in humans was reported to start on days 1 to 7 postexposure, delaying the initiation of treatment by 24 to 48 h (time frame for mass distribution of antibiotics) may result in sick populations. We evaluated the efficacy of antibiotic administration as a function of bacteremia levels at the time of treatment initiation. Here we compare the efficacy of treatment with clarithromycin, amoxicillin-clavulanic acid (Augmentin), imipenem, vancomycin, rifampin, and linezolid to the previously reported efficacy of doxycycline and ciprofloxacin. We demonstrate that treatment with amoxicillin-clavulanic acid, imipenem, vancomycin, and linezolid were as effective as doxycycline and ciprofloxacin, curing rabbits exhibiting bacteremia levels of up to 10(5) CFU/ml. Clarithromycin and rifampin were shown to be effective only as a postexposure prophylactic treatment but failed to treat the systemic (bacteremic) phase of anthrax. Furthermore, we evaluate the contribution of combined treatment of clindamycin and ciprofloxacin, which demonstrated improvement in efficacy compared to ciprofloxacin alone.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bacteremia; Ciprofloxacin; Clarithromycin; Disease Models, Animal; Doxycycline; Drug Combinations; Drug Synergism; Humans; Imipenem; Linezolid; Male; Microbial Sensitivity Tests; Rabbits; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survival Analysis; Vancomycin

Topics: Antibiotics, Antitubercular; Drug Resistance, Bacterial; Female; Humans; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Respiratory Tract Infections; Rifampin; Tuberculosis; Tuberculosis, Pulmonary

For many respiratory infections caused by multidrug-resistant Gram-negative bacteria, colistin is the only effective antibiotic despite its nephrotoxicity. A novel inhaled combination formulation of colistin with a synergistic antimicrobial component of rifampicin was prepared via co-spray drying, aiming to deliver the drug directly to the respiratory tract and minimize drug resistance and adverse effects. Synergistic antibacterial activity against Acinetobacter baumannii was demonstrated for the combination formulation with high emitted doses (96%) and fine particle fraction total (FPFtotal; 92%). Storage of the spray-dried colistin alone formulation in the elevated relative humidity (RH) of 75% resulted in a substantial deterioration in the aerosolization performance because the amorphous colistin powders absorbed significant amount of water up to 30% by weight. In contrast, the FPFtotal values of the combination formulation stored at various RH were unchanged, which was similar to the aerosolization behavior of the spray-dried rifampicin-alone formulation. Advanced surface chemistry measurements by XPS and ToF-SIMS demonstrated a dominance of rifampicin on the combination particle surfaces, which contributed to the moisture protection at the elevated RH. This study shows a novel inhalable powder formulation of antibiotic combination with the combined beneficial properties of synergistic antibacterial activity, high aerosolization efficiency, and moisture protection.

Topics: Acinetobacter baumannii; Administration, Inhalation; Aerosols; Anti-Bacterial Agents; Colistin; Drug Combinations; Drug Synergism; Humans; Humidity; Mass Spectrometry; Microbial Sensitivity Tests; Particle Size; Photoelectron Spectroscopy; Powders; Respiratory Tract Infections; Rifampin

The Burkholderia cepacia complex (Bcc) represents an important group of pathogens involved in long-term lung infection in cystic fibrosis (CF) patients. A positive selection of hypermutators, linked to antimicrobial resistance development, has been previously reported for Pseudomonas aeruginosa in this chronic infection setting. Hypermutability, however, has not yet been systematically evaluated in Bcc species. A total of 125 well characterized Bcc isolates recovered from 48 CF patients, 10 non-CF patients and 15 environmental samples were analyzed. In order to determine the prevalence of mutators their spontaneous mutation rates to rifampicin resistance were determined. In addition, the genetic basis of the mutator phenotypes was investigated by sequencing the mutS and mutL genes, the main components of the mismatch repair system (MRS). The overall prevalence of hypermutators in the collection analyzed was 13.6%, with highest occurrence (40.7%) among the chronically infected CF patients, belonging mainly to B. cenocepacia, B. multivorans, B. cepacia, and B. contaminans -the most frequently recovered Bcc species from CF patients worldwide. Thirteen (76.5%) of the hypermutators were defective in mutS and/or mutL. Finally, searching for a possible association between antimicrobial resistance and hypermutability, the resistance-profiles to 17 antimicrobial agents was evaluated. High antimicrobial resistance rates were documented for all the Bcc species recovered from CF patients, but, except for ciprofloxacin, a significant association with hypermutation was not detected. In conclusion, in the present study we demonstrate for the first time that, MRS-deficient Bcc species mutators are highly prevalent and positively selected in CF chronic lung infections. Hypermutation therefore, might be playing a key role in increasing bacterial adaptability to the CF-airway environment, facilitating the persistence of chronic lung infections.

Topics: Anti-Bacterial Agents; Burkholderia cepacia complex; Burkholderia Infections; Chronic Disease; Cohort Studies; Cystic Fibrosis; DNA Mismatch Repair; DNA Repair Enzymes; DNA, Bacterial; Drug Resistance, Bacterial; Environmental Microbiology; Humans; Molecular Sequence Data; Mutation Rate; Respiratory Tract Infections; Rifampin; Sequence Analysis, DNA

To study the incidence of rifampicin-resistant Staphylococcus aureus in Gipuzkoa, Northern Spain, and to characterize representative resistant isolates and mutations associated with resistance.. For rifampicin-resistant isolates, the rpoB gene fragment that includes the most frequent mutations conferring rifampicin resistance in S. aureus was amplified and sequenced. The role of new mutations responsible for rifampicin resistance was confirmed by cloning and complementation in trans. Resistant isolates were characterized by multilocus sequence typing and PFGE.. Between 1999 and 2008, 0.59% (96/16 348) of S. aureus clinical isolates studied showed rifampicin resistance. Rifampicin resistance was higher in methicillin-resistant S. aureus (MRSA) than in methicillin-susceptible S. aureus (MSSA) (3.26% versus 0.26%; P < 0.001). Twenty-two randomly selected rifampicin-resistant isolates were studied in depth, 11 showing low-level and 11 showing high-level rifampicin resistance (rifampicin MICs of 2-4 mg/L and ≥8 mg/L, respectively). Overall, 12 different mutations in the rpoB gene were detected, including a newly described N474K mutation followed by the insertion of a glycine residue at position 475. Among the eight different sequence types (STs) found, the most frequent were ST8 and ST863, the latter being associated with respiratory infections. Ten of the 11 low-level rifampicin-resistant isolates were MRSA ST8 and had the same H481N mutation, while the 11 high-level rifampicin-resistant isolates, 6 MSSA and 5 MRSA, belonged to eight different STs and had distinct rpoB mutations.. Low-level rifampicin-resistant isolates were mainly clonal while high-level resistant isolates showed a high genetic diversity. Most mutations observed coincided with those found in other studies, but a new mutation conferring rifampicin resistance was detected.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Child; Cloning, Molecular; DNA-Directed RNA Polymerases; DNA, Bacterial; Drug Resistance; Electrophoresis, Gel, Pulsed-Field; Female; Genetic Complementation Test; Genotype; Humans; Incidence; Male; Middle Aged; Multilocus Sequence Typing; Polymorphism, Genetic; Respiratory Tract Infections; Rifampin; Sequence Analysis, DNA; Spain; Staphylococcal Infections; Staphylococcus aureus; Wound Infection; Young Adult

Topics: Animals; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Clarithromycin; Horse Diseases; Pulmonary Alveoli; Respiratory Tract Infections; Rifampin

Elderly patients living in nursing homes can easily find themselves unable to carry out their daily activities, once they become ill, even with infectious diseases of a slight to mild degree, and rapid treatment is required to cure them of their malaise. However, treatment is often difficult due to the presence of drug-resistant bacteria. This study was designed to evaluate the efficacy of the selective use of antimicrobial agents based on a sensitivity test of isolated bacteria.. Possible pathogenic bacteria were isolated from cultures of pharyngeal swabs or urine obtained from patients with chronic febrile conditions or urinary tract infections, resistant to antimicrobial treatment. The efficacy of the treatment was evaluated based on release from febrile conditions and improvement of activities of daily living (ADL) accompanied by the disappearance of possible pathogenic bacteria following the use of selective antimicrobial agents.. The outcome of 14 cases with sustaining febrile conditions and 3 cases with urinary tract infections was reviewed. Most of them showed a good response to treatment with remarkable improvement in ADL. In some cases, patients were switched from one antimicrobial agent to another each time new pathogenic bacteria were detected in the culture. A combination of rifampicin and sulfamethoxazole/trimethoprim (RFP/ST) was found to be the most convenient and effective treatment in patients with MRSA or drug-resistant Streptococcus pneumoniae. Levofloxacin (LVFX)-resistant Escherichia coli were detected together with MRSA in our 3 patients with urinary tract infections, corresponding to the frequent use of LVFX in our community.. Identification of possible pathogenic bacteria and the use of proper antibiotic agents based on a sensitivity test are very effective in the treatment of elderly patients with chronic febrile conditions arising from the presence of drug-resistant bacteria. Careful use of fluoroquinolones is required in patients in whom MRSA is or had once been detected. This is beneficial not only for the elderly patients themselves but is also useful in preventing the spread of drug-resistant bacteria.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Antibiotics, Antitubercular; Drug Resistance, Bacterial; Female; Homes for the Aged; Humans; Male; Nursing Homes; Respiratory Tract Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Kingella kingae often colonizes the oropharyngeal and respiratory tracts of children but infrequently causes invasive disease. In mid-October 2003, 2 confirmed and 1 probable case of K kingae osteomyelitis/septic arthritis occurred among children in the same 16- to 24-month-old toddler classroom of a child care center. The objective of this study was to investigate the epidemiology of K kingae colonization and invasive disease among child care attendees.. Staff at the center were interviewed, and a site visit was performed. Oropharyngeal cultures were obtained from the staff and children aged 0 to 5 years to assess the prevalence of Kingella colonization. Bacterial isolates were subtyped by pulsed-field gel electrophoresis (PFGE), and DNA sequencing of the 16S rRNA gene was performed. A telephone survey inquiring about potential risk factors and the general health of each child was also conducted. All children and staff in the affected toddler classroom were given rifampin prophylaxis and recultured 10 to 14 days later. For epidemiologic and microbiologic comparison, oropharyngeal cultures were obtained from a cohort of children at a control child care center with similar demographics and were analyzed using the same laboratory methods. The main outcome measures were prevalence and risk factors for colonization and invasive disease and comparison of bacterial isolates by molecular subtyping and DNA sequencing.. The 2 confirmed case patients required hospitalization, surgical debridement, and intravenous antibiotic therapy. The probable case patient was initially misdiagnosed; MRI 16 days later revealed evidence of ankle osteomyelitis. The site visit revealed no obvious outbreak source. Of 122 children in the center, 115 (94%) were cultured. Fifteen (13%) were colonized with K kingae, with the highest prevalence in the affected toddler classroom (9 [45%] of 20 children; all case patients tested negative but had received antibiotics). Six colonized children were distributed among the older classrooms; 2 were siblings of colonized toddlers. No staff (n = 28) or children aged <16 months were colonized. Isolates from the 2 confirmed case patients and from the colonized children had an indistinguishable PFGE pattern. No risk factors for invasive disease or colonization were identified from the telephone survey. Of the 9 colonized toddlers who took rifampin, 3 (33%) remained positive on reculture; an additional toddler, initially negative, was positive on reculture. The children of the control child care center demonstrated a similar degree and distribution of K kingae colonization; of 118 potential subjects, 45 (38%) underwent oropharyngeal culture, and 7 (16%) were colonized with K kingae. The highest prevalence again occurred in the toddler classrooms. All 7 isolates from the control facility had an indistinguishable PFGE pattern; this pattern differed from the PFGE pattern observed from the outbreak center isolates. 16S rRNA gene sequencing demonstrated that the outbreak K kingae strain exhibited >98% homology to the ATCC-type strain, although several sequence deviations were present. Sequencing of the control center strain demonstrated more homology to the outbreak center strain than to the ATCC-type strain.. This is the first reported outbreak of invasive K kingae disease. The high prevalence in the affected toddler class and the matching PFGE pattern are consistent with child-to-child transmission within the child care center. Rifampin was modestly effective in eliminating carriage. DNA sequence analysis suggests that there may be considerable variability within the species K kingae and that different K kingae strains may demonstrate varying degrees of pathogenicity.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Child Day Care Centers; Child, Preschool; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Humans; Infant; Kingella kingae; Minnesota; Neisseriaceae Infections; Oropharynx; Osteomyelitis; Respiratory Tract Infections; Rifampin; Sequence Analysis, DNA

To investigate the antibiotics-resistance type and molecular epidemiology of Streptococcus pneumoniae isolated from children in Hangzhou.. The sensitivities of 323 strains of Streptococcus pneumoniae to 9 antibiotics were determined in vitro by Kirby-Bauer diffuse methods, and MICs of penicillin and cefotaxime were determined by E-test methods.. Among all 323 strains isolated from children during the period from August 2001 to July 2002, 136 strains (42.1%) were sensitive to penicillin, while 57 strains (17.7%) were penicillin-resistant. Penicillin MICs ranged from 0.012 microg/ml to 4.0 microg/ml. All the strains were sensitive to cefotaxime and its MICs ranged from 0.012 microg/ml to 4.0 microg/ml. The most resistant antibiotic was erythromycin and it's resistant-rate was as high as 90.7%, followed by tetracycline (87.6%), trimethoprim-sulfamethoxazole (48.6%) and chloromycetin (14.9%). Totally 197 strains (61.0%) were multi-drug-resistant pneumococci and most of them were resistant to trimethoprim-sulfamethoxazole, erythromycin and tetracycline at the same time. Two strains (0.6%) were resistant to rifampin and none was resistant to vancomycin and ofloxacin. BOX PCR typing was carried out and no overwhelming fingerprinting pattern was found among penicillin resistant Streptococcus pneumoniae strains which were isolated from patients, while the banding patterns were always similar or identical among the strains isolated from the same specimen or from the same patient at different time, respectively.. The antibiotics-resistant rate of pneumococci was high in Hangzhou, but the third-generation cephalosporins were still the best antibiotics against Streptococcus pneumoniae. One child could be infected or colonized by more than one pneumococci clone at the same or different time.

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; China; Chloramphenicol; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Pneumococcal Infections; Respiratory Tract Infections; Rifampin; Streptococcus pneumoniae; Tetracycline; Trimethoprim

Topics: Adult; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Female; Helicobacter Infections; Humans; Male; Middle Aged; Mycobacterium Infections; Respiratory Tract Infections; Rifampin

Attempts were made to select mutants on agar media containing the new ketolide ABT-773, erythromycin or rifampicin, at concentrations above the MICs, from Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae, including erythromycin-resistant strains. ABT-773 did not select for mutants in four strains, whereas in eight strains the frequencies at 72 h were < or = 10(-9). ABT-773 MICs were 0.015-4 mg/L for mutants, except those selected from inducible Erm(A) S. aureus. Mutants selected on ABT-773 or erythromycin were cross-resistant to ABT-773, erythromycin and, sometimes, clindamycin. The susceptibility profiles indicate that different mutations were selected and that ABT-773 and erythromycin may interact with the ribosome differently.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteria; Culture Media; Erythromycin; Haemophilus influenzae; Ketolides; Microbial Sensitivity Tests; Mutation; Phenotype; Respiratory Tract Infections; Rifampin; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes

This study evaluated whether certain antimicrobial agents used in the treatment of community-acquired respiratory infection were effective against the pathogen Neisseria meningitidis, whose natural habitat is the nasopharyngeal mucosa. Antimicrobial agents commonly use in primary healthcare (betalactams, cephalosporins and macrolides), quinolones and rifampicin were studied by determining minimal inhibitory and bactericidal concentrations, time-kill curves and postantibiotic effect. All of them showed bactericidal activity 24 h after incubation. We therefore believe that they are able to empirically eliminate the causative agent of meningococcal meningitis. However, the only antimicrobial agents capable of inducing a significant postantibiotic effect in the tested strain were the quinolones, which slowed down the growth of the microorganism for over 1 h.

Topics: Amoxicillin; Anti-Infective Agents; Ciprofloxacin; Clarithromycin; Community-Acquired Infections; Drug Resistance; Fluoroquinolones; Humans; Meningococcal Infections; Microbial Sensitivity Tests; Naphthyridines; Nasopharynx; Neisseria meningitidis; Respiratory Tract Infections; Rifampin; Time Factors

The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.

Topics: Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bioterrorism; Blood; Ciprofloxacin; Clindamycin; District of Columbia; Dyspnea; Fever; Humans; Lymphatic Diseases; Male; Mediastinal Diseases; Middle Aged; Occupational Exposure; Pleural Effusion; Polymerase Chain Reaction; Postal Service; Radiography, Thoracic; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survivors; Tomography, X-Ray Computed

Topics: Adult; Anti-Infective Agents; Antitubercular Agents; Fluoroquinolones; Humans; Isoniazid; Middle Aged; Quinolones; Respiratory Tract Infections; Rifampin; Treatment Outcome; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

In continuous flow biofilm cultures in medium resembling cystic fibrosis bronchial secretions, Pseudomonas aeruginosa was not eradicated from biofilms by 1 week of treatment with high concentrations of ceftazidime and gentamicin, to which the strains were sensitive on conventional testing. The addition of rifampicin, which has little activity against the strains as measured by the minimum inhibitory concentration, led to the apparent elimination of the bacteria from the biofilms. The effect was not strain specific.

Topics: Anti-Bacterial Agents; Biofilms; Bronchi; Ceftazidime; Cephalosporins; Cystic Fibrosis; Drug Synergism; Drug Therapy, Combination; Gentamicins; Humans; Polysaccharides, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Time Factors

We describe a case of recurrent Stomatococcus mucilaginosus lower respiratory tract infection in a patient with AIDS. Apart from S. mucilaginosus no other pathogens were found to account for infection. There was a rapid response to rifampicin, the organism being resistant to penicillin, co-trimoxazole and ciprofloxacin. Infections caused by this organism are increasingly described, but there are few reports of lower respiratory tract infection.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Gram-Positive Cocci; Humans; Male; Respiratory Tract Infections; Rifampin

The in-vitro activity of RP 59500, a new semisynthetic injectable streptogramin, was compared with that of erythromycin, rifampicin and ciprofloxacin against 189 Legionella spp. Rifampicin was the most active agent tested. RP 59500 was found to be more active than erythromycin against most strains, but less active than ciprofloxacin. Legionella pneumophila serogroups 1, 3, 4, 5 and 6 were more susceptible to RP 59500 than were L. pneumophila serogroups 2, 7, and 8. Legionella micdadei was the least susceptible species to RP 59500 and erythromycin. RP 59500 was similar in activity against isolates obtained from both patients and environmental sources. This activity was generally better than that of erythromycin.

Topics: Ciprofloxacin; Cross Infection; Drug Resistance, Microbial; Erythromycin; Humans; In Vitro Techniques; Legionella; Microbial Sensitivity Tests; Respiratory Tract Infections; Rifampin; Virginiamycin

Topics: Adolescent; Carrier State; Child; Ethambutol; Health Resorts; Humans; Isoniazid; Respiratory Tract Infections; Rifampin; Tuberculin Test; Tuberculosis, Pulmonary; Ukraine

In August 1987, an outbreak of group A meningococcal meningitis occurred during the annual pilgrimage to Mecca, Saudi Arabia, resulting in an attack rate among American pilgrims of 640 per 100,000. To determine risk factors for carriage, throat cultures were taken from passengers arriving on four consecutive flights from Saudi Arabia to the United States. Pilgrims were more likely to be group A meningococcal carriers than were nonpilgrims (relative risk, 11.1; 95% confidence interval, 3.7 to 33.1). Smoking, crowding, and meningococcal vaccination were not significantly associated with group A carriage. Pilgrims complaining of recent fever or sore throat, however, were more likely to be group A carriers, consistent with previous reports linking carriage and disease to preceding viral infections. Serogrouping of invasive meningococcal isolates can be used to monitor for indigenous transmission of this unusual strain in the United States, and we recommend routine vaccination of pilgrims to prevent future outbreaks of meningococcal disease.

Topics: Adolescent; Adult; Aged; Bacterial Vaccines; Carrier State; Child, Preschool; Disease Outbreaks; Female; Humans; Male; Meningitis, Meningococcal; Meningococcal Vaccines; Middle Aged; Respiratory Tract Infections; Rifampin; Risk Factors; Saudi Arabia; Seasons; Travel; United States

Clinical efficacy of rifampicin, a semisynthetic broad spectrum antibiotic was estimated in 247 patients with purulent inflammations. It was shown advisable to use rifampicin intravenously in treatment of severe bronchopulmonary pathology, disorders of the bile excretion system, osteomyelitis, severe wound infections and in prophylaxis of postoperative purulent complications in cardiovascular surgery and other cases. High rifampicin sensitivity of staphylococci and streptococci belonging to various species was revealed. Rifampicin was found to be less active against gramnegative pathogens. The isolation frequency of rifampicin sensitive strains of E. coli, Proteus spp., Klebsiella spp. and P. aeruginosa amounted to 88.4, 52.1, 58.8 and 49.3 per cent respectively.

Topics: Bacteria; Bacterial Infections; Cholangitis; Drug Resistance, Microbial; Hepatitis; Humans; Osteomyelitis; Respiratory Tract Infections; Rifampin; Wound Infection

Thirty-two patients were treated by ofloxacin on bacteriological documented infections. They were Enterobacterias: n = 15 (MIC less than or equal to 0.06 to 0.5 microgram/ml); Pseudomonas aeruginosa and Acinetobacter: n = 1 (MIC 0.5 and 4 micrograms/ml); Staphylococcus: n = 6 (MIC less than or equal to 0.06 to 4 micrograms/ml); Pneumococcus: n = 1; Mycoplasma: n = 1; Chlamydia psittaci: n = 2; Legionella pneumophila: n = 1; Rickettsias: n = 4 (three mediterranean fevers one query fever). Ofloxacin was given orally from 400 to 800 mg per day (5 to 15 mg/kg/day). It was used alone 26 times and on 6 occasions it was associated with rifampin on 6 staphylococcal infections. On 19 cases it was used after failure or intolerance of initial therapy. Thirty times it was the first antibiotic substance used. Results were good mainly: 1) on nine pneumonitis (enterobacterias: 4; Pneumococcus: 1; Mycoplasma: 1; Chlamydia: 2; Legionella: 1) during a mean duration of twenty days; 2) urinary infections (n:7) provoked by E. coli and Enterobacter cloacae (mean duration: 20 days); 3) 4 osteo-articular-infections (mean duration: 77 days); 4) Rickettsial infections (n:4) during a mean duration of 11 days. Results are particularly noteworthy because patients treated had severe infections: 12 bacteremias, 1 endocarditis and 1 purulent meningitis. None severe adverse effect was observed.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Ofloxacin; Oxazines; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Urinary Tract Infections

The increasing incidence of Haemophilus influenzae resistant to ampicillin has clinical implications not only for pediatricians but also for family physicians, because the bacterium is recognized more frequently as the etiologic agent for diseases in adults as well as in young children. Ampicillin is no longer the automatic choice for treatment of patients thought to have life-threatening H influenzae disease, and empiric treatment of otitis media must be reexamined. Chloramphenicol, as well as ampicillin, must be considered for the treatment of meningitis and other serious systemic H influenzae infections. Once the infective organism has been isolated and tested for resistance, ampicillin alone may be used if indicated or desired. Alternatives to ampicillin for middle ear infection are trimethoprim-sulfamethoxazole (Bactrim, Septra), erythromycin-sulfonamide (Pediazole), and cefaclor (Ceclor). Isolation and susceptibility tests are seldom done because they necessitate tympanocentesis.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Otitis Media; Penicillin Resistance; Pneumonia; Respiratory Tract Infections; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Kidney Injury; Adult; Female; Humans; Kidney; Kidney Tubular Necrosis, Acute; Male; Middle Aged; Respiratory Tract Infections; Rifampin; Tuberculosis, Pulmonary

Erythromycin and rifampicin (rifampin) were able to prevent death of guineapigs given intraperitoneal injections of the agent causing legionnaires' disease. Penicillin, chloramphenicol, tetracycline, and gentamicin showed no significant effect. On the basis of clinical experience and experimental observations, erythromycin is recommended for patients suspected to have legionnaires' disease. Combined therapy with erythromycin and rifampicin may be justified in patients with confirmed legionnaires' disease who are not responding to erythromycin alone or as part of a controlled antibiotic trial among suspected cases during an outbreak of legionnaires' disease.

Topics: Administration, Oral; Animals; Chloramphenicol; Disease Models, Animal; Drug Evaluation; Drug Evaluation, Preclinical; Drug Therapy, Combination; Erythromycin; Female; Gentamicins; Guinea Pigs; Injections, Subcutaneous; Legionnaires' Disease; Penicillins; Respiratory Tract Infections; Rifampin; Tetracycline

Paired sera from victims of Legionnaires' disease showed, in many cases, significant rises in immunoglobulin G antibodies to both the causative agent (LA) of Legionnaires' disease and Chlamydia psittaci, but concurrent rises in immunoglobulin M antibodies only against LA. Guinea pigs experimentally infected with LA likewise responded with antibodies to both C. psittaci and LA. Guinea pigs infected with LA also reflected significant differences in antigenic makeup and in pathogenicity among four strains of LA examined. In antibiotic studies, rifampin was 200 times more effective than erythromycin and 17,000 times more effective than tetracycline in plaque reduction tests of LA in monolayer cultures of primary chick embryo cells. An isolate of LA recovered from a healthy person was compared with three isolates from persons with fatal infections.

Topics: Animals; Antibodies, Viral; Antigens, Viral; Chlamydophila psittaci; Fluorescent Antibody Technique; Guinea Pigs; Humans; Immunoglobulin G; Immunoglobulin M; Microbial Sensitivity Tests; Respiratory Tract Infections; Rifampin; Tetracycline

After the oral administration of 600 mg rifampicin, we determined the rifampicin level of the lung tissue of 18 operated patients, as well as the rifampicin level of the pleural callus of one patient, that of the pericardial cyst of another, and the serum level of all the 20 patients. The serum level amounted to an average of 6.5 mcg/ml between 2 and 6hours after administration, and to 3.3 mcg/ml between 8 and 9 hours. The lung tissue level amounted to an average of 2.3 mcg/g. The lung rifampicin level reached 32-44-62 per cent of the serum level 2 to 9 hours after its administration. This concentration was found to meet treatment requirements of Mycobacterium tuberculosis, Gram-positive cocci, and certain Gram-negative bacteria-induced airway infections.

Topics: Administration, Oral; Adult; Female; Humans; Kinetics; Lung; Male; Middle Aged; Respiratory Tract Infections; Rifampin; Tuberculosis, Pulmonary

Topics: Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cephalothin; Child; Child, Preschool; Chlortetracycline; Gentamicins; Humans; Infant; Neomycin; Penicillins; Respiratory Tract Infections; Rifampin; Streptomycin

Topics: Aged; Diagnosis, Differential; Epiglottis; Esophageal Neoplasms; Hospitals, General; Humans; Ileocecal Valve; Isoniazid; Laryngeal Neoplasms; Laryngoscopy; Male; Otitis Media; Pharyngitis; Radiography; Respiratory Tract Infections; Rifampin; Tongue Diseases; Tonsillitis; Tuberculosis; Tuberculosis, Gastrointestinal; Tuberculosis, Laryngeal; Tuberculosis, Oral; Tuberculosis, Pulmonary

Topics: Adrenal Cortex Hormones; Arthritis, Rheumatoid; Azathioprine; Cephalosporins; Humans; Liver Abscess, Amebic; Metronidazole; Purpura, Thrombocytopenic; Respiratory Tract Infections; Rifampin; Sarcoidosis; Urinary Tract Infections

Determination of the minimum inhibitory concentrations of rifamide necessary to inhibit organisms isolated from the biliary tract showed that the organisms were almost invariably sensitive to concentrations which are readily attainable in the biliary tract. Three cases of severe acute inflammation of the biliary tract were treated and this led to rapid clinical improvement. In 61 patients undergoing biliary surgery a random group was given rifamide 150 mg twice daily, beginning 24 hours before operation and continuing for three days afterwards. In the untreated group eight patients had infected bile at operation and five subsequently developed a wound infection. In the rifamide group three had infected bile at operation and only one developed a wound infection. A similar number of postoperative chest infections occurred in each group of patients. There is some evidence of reduction in length of hospital stay in the treated patients.

Topics: Acute Disease; Aged; Bile; Cholangitis; Cholecystitis; Cholelithiasis; Female; Gallbladder; Humans; Length of Stay; Male; Microbial Sensitivity Tests; Postoperative Complications; Respiratory Tract Infections; Rifampin; Surgical Wound Infection

Topics: Bronchial Diseases; Drug Resistance, Microbial; Haemophilus influenzae; Humans; Neisseria; Respiratory Tract Infections; Rifampin; Streptococcus; Streptococcus pneumoniae

Topics: Administration, Oral; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Rifampin; Scarlet Fever

Topics: Chronic Disease; Humans; Infections; Nitrogen; Pneumococcal Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Tuberculosis, Pulmonary; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Child; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Respiratory Tract Infections; Rifampin; Skin Diseases, Infectious; Urinary Tract Infections

Topics: Abscess; Adult; Aged; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Rifampin; Tonsillitis; Tuberculosis; Urinary Tract Infections

Topics: Abscess; Bronchopneumonia; Empyema; Enteritis; Humans; Pharyngitis; Pneumonia; Respiratory Tract Infections; Rhinitis; Rifampin; Skin Diseases

Topics: Bacteria; Humans; Respiratory Tract Infections; Rifampin

Topics: Antitubercular Agents; Humans; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Staphylococcus; Tuberculosis, Pulmonary; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Rifampin

Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Respiratory Tract Infections; Rifampin