rifampin and Streptococcal-Infections

Psoriasis is a chronic skin disease that affects approximately two per cent of the general population. Plaque psoriasis is the most common form: it usually appears as raised, red patches of inflamed skin, covered with silvery white scales. The patches often occur in a symmetrical pattern. Guttate psoriasis is a particular form of psoriasis with widespread, small erythematosquamous lesions. Streptococcal infection is suspected to be a triggering factor for the onset of guttate psoriasis, and flare-up of chronic plaque psoriasis. The previous Cochrane Review on this topic was published in 2000; it required an update because antistreptococcal treatment continues to be used to treat psoriasis, especially for the acute form of guttate psoriasis.. To assess the effects of antistreptococcal interventions for guttate and chronic plaque psoriasis.. We searched Cochrane Skin Specialised Register, Cochrane Register of Studies Online, CENTRAL, MEDLINE, Embase, LILACS, and five trials registers (January 2019). We checked the reference lists of included and excluded studies and searched conference proceedings from the American Academy of Dermatology, Society for Investigative Dermatology, and European Academy of Dermatology and Venereology.. We considered randomised controlled trials (RCTs) assessing antistreptococcal interventions (tonsillectomy or systemic antibiotic treatment) in people with clinically diagnosed acute guttate and chronic plaque psoriasis compared with placebo, no intervention, or each other.. We used standard methodological procedures expected by Cochrane. Primary outcome measures were: 1) time-to-resolution; achieving clear or almost clear skin (Physician Global Assessment (PGA) 0 or 1 or Psoriasis Area and Severity Index (PASI) 90 or 100); 2) proportion of participants with adverse effects and severe adverse effects. Secondary outcomes were: 1) proportion of participants achieving clear or almost clear skin; 2) proportion of participants achieving PASI 75 or PGA 1 to 2; 3) risk of having at least one relapse at long-term follow-up. Short-term assessment was defined as within eight weeks of the start of treatment; long-term was at least one year after the start of treatment.. We included five trials (162 randomised participants); three were conducted in a hospital dermatology department. One study declared funding by a pharmaceutical company. Participants' ages ranged from 12 to 77 years; only two participants were younger than 15 years. Mean PASI score at baseline varied from 5.7 (i.e. mild) to 23 (i.e. severe) in four studies. Twenty-three of 162 participants had streptococcus-positive throat swab culture. We did not perform a meta-analysis due to heterogeneity of participants' characteristics and interventions.None of the trials measured our efficacy primary outcome, time-to-resolution, or the secondary outcome, risk of having at least one relapse at long-term follow-up.We rated the quality of the results as very low-quality evidence, due to high risk of bias (absence of blinding of participants and caregivers, and high risk of outcome reporting bias) and imprecision (single study data with a low number of events). Hence, we are very uncertain about the results presented.Guttate psoriasisOne three-armed trial (N = 43) assessed penicillin (50,000 international units (IU)/kg/day in three doses) versus erythromycin (250 mg four times per day) versus no treatment (treatment for 14 days, with six-week follow-up from start of treatment). Adverse events and the proportion of participants achieving clear or almost clear skin were not measured.One trial (N = 20) assessed penicillin (1.6 MU (million units) intramuscularly once a day) versus no treatment (six weeks of treatment, with eight-week follow-up from start of treatment). At six-week (short-term) follow-up, no adverse events were observed in either group, and there was no statistically significant difference between the two groups in the proportion of participants with clear or almost clear skin (risk ratio (RR) 2.00, 95% confidence interval (CI) 0.68 to 5.85).One trial (N = 20) assessed rifampicin (300 mg twice daily) versus placebo (14-day treatment duration; six-week follow-up from start of treatment); none of the review outcomes were measured.These trials did not measure the proportion of participants achieving PASI 75 or PGA 1 to 2.Chronic plaque psoriasisOne trial (N = 50) assessed long-term azithromycin treatment (500 mg daily dose) versus vitamin C. Adverse events were reported in the azithromycin group (10 out of 30 had nausea and mild abdominal upset), but not in the vitamin C group. The proportion of participants who achieved clear or almost clear skin was not measu. We found only five trials (N = 162), which assessed the effects of five comparisons (systemic antibiotic treatment (penicillin, azithromycin) or tonsillectomy). Two comparisons (erythromycin compared to no treatment, and rifampicin compared to placebo) did not measure any of the outcomes of interest. There was very low-quality evidence for the outcomes that were measured, Therefore, we are uncertain of both the efficacy and safety of antistreptococcal interventions for guttate and chronic plaque psoriasis.The included trials were at unclear or high risk of bias and involved only a small number of unrepresentative participants, with limited measurement of our outcomes of interest. The studies did not allow investigation into the influence of Streptococcal infection, and a key intervention (amoxicillin) was not assessed.Further trials assessing the efficacy and tolerance of penicillin V or amoxicillin are needed in children and young adults with guttate psoriasis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ascorbic Acid; Azithromycin; Child; Erythromycin; Humans; Middle Aged; Penicillin V; Psoriasis; Randomized Controlled Trials as Topic; Rifampin; Streptococcal Infections; Tonsillectomy; Vitamins

Combinations of rifampin and clindamycin or rifampin, metronidazole, and moxifloxcin have been reported as effective treatments for hidradenitis suppurativa (HS) Hurley Stage 1 and Hurley Stage 2.  Clinical trials suggest that for stage 1 and mild stage 2 HS, clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks can substantially abate HS in ~80% of cases and remit HS in ~50% of cases.  Another study notes use of rifampin-moxifloxacin-metronidazole given for 6 weeks, dosed as rifampin (10 mg/kg once daily), moxifloxacin (400 mg daily), and metronidazole (500 mg thrice daily) with the metronidazole stopped at week 6.   Rifampin and moxifloxacin were continued if the HS improved and side effects did not occur.  Using this triple antibiotic regimen remission occurred in 100% Hurley Stage 1, 80% Hurly Stage 2, and 16.7 % of Hurley Stage 3 HS.   The author typically gives HS clindamycin 300 mg and rifampin 300 mg, each twice daily, for 10 weeks and assesses if remission has occurred.  If the patient has not achieved remission the author continues the regimen as long as the patient's clinical status continues to improve without side effects.  The reasons why rifampin is so effective against HS have not been fully defined and might involve rifampin's (1) antibacterial effects (2) effects on bacterial biofilms (3) anti-inflammatory effects (4) effects against granulomas (5) and immunomodulatory effects on neutrophils.  It is notable that rifampin, although not first line, is an effective treatment for Clostridium difficile, a pathogen that arises during treatment with clindamycin.  Thus, rifampin enhances safety when rifampin and clindamycin are combined for the treatment of HS.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Biofilms; Clindamycin; Corynebacterium Infections; Drug Therapy, Combination; Granuloma; Hidradenitis Suppurativa; Humans; Immunologic Factors; Neutrophils; Rifampin; Staphylococcal Infections; Streptococcal Infections

Bacterial meningitis caused by Streptococcus pneumoniae is an important cause of neurological morbidity and mortality in both children and adults. With increasing antibiotic resistance in pneumococci and documented microbiological failure in treatment of pneumococcal meningitis with cefotaxime and ceftriaxone, the need for alternative antibiotic therapy is critical. Of the currently available options, vancomycin has shown the most promise, particularly when used in combination with ceftriaxone or cefotaxime. Rifampin, also used in combination with either ceftriaxone or cefotaxime, has demonstrated encouraging preliminary results against antibiotic-resistant pneumococci as well. Chloramphenicol has unexpectedly yielded discouraging clinical results in children with infection caused by penicillin-resistant strains. Of the investigational antibiotics currently in clinical trials for the treatment of meningitis, meropenem, a carbapenem-class antibiotic, has demonstrated increased activity against penicillin-resistant pneumococci compared with that of other beta-lactam antibiotics, while having a safety profile similar to that of the cephalosporins.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Chloramphenicol; Clindamycin; Female; Fluoroquinolones; Humans; Infant; Infant, Newborn; Lactams; Male; Meningitis, Bacterial; Naphthyridines; Penicillin Resistance; Rifampin; Streptococcal Infections; Streptococcus pneumoniae; Vancomycin; Virginiamycin

Topics: Ampicillin; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Rifampin; Streptococcal Infections; Streptococcus agalactiae

Topics: Anti-Bacterial Agents; Antitubercular Agents; Cephalosporins; Endocarditis, Bacterial; Enteritis; Gentamicins; Humans; Infections; Lincomycin; Meningitis; Penicillins; Rifampin; Sepsis; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Urinary Tract Infections; Vancomycin

The efficacy of traditional systemic therapies for psoriasis is limited by various side effects, toxicity, drug-drug interactions, and the need for frequent laboratory monitoring. In animal models, rifampicin causes immunosuppression and in conventional doses it suppresses the T-cell function.. To show that rifampicin has a therapeutic effect in eruptive psoriasis and to try to explain its mode of action.. A total of 76 patients (34 men and 42 women, aged between 12 and 68 years) with eruptive psoriasis were enrolled in the study. They were divided into two groups according to the evidence of a concomitant streptococcal infection. Rifampicin was administered orally in a 600 mg daily dosage for at least 60 days. Only emollients were given for topical therapy.. A statistical (chi-squared test) analysis was done and it could be concluded that improvement in the two groups was statistically indistinguishable (p = 0.892), while comparison with the control group showed a significant difference (p = 0.00082).. The results express that there is no statistically significant difference between the treating groups and the effect of rifampicin could not be related only to its antimicrobial properties. Its therapeutic effect most probably is due to its immunosuppressive properties.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Female; Humans; Male; Middle Aged; Psoriasis; Rifampin; Streptococcal Infections; Treatment Outcome

Mucous membrane colonization with group B streptococci (GBS) frequently persists in infants after treatment of invasive infection and may be associated with recurrent disease.. To determine the frequency with which GBS colonization persists at mucous membrane sites after treatment of invasive early or late onset infection and to determine the efficacy of oral rifampin in eradicating colonization in these infants and their mothers.. Cultures for isolation of GBS were obtained from infants and their mothers after completion of the infant's parenteral therapy, 1 week later when rifampin therapy was initiated and at approximately 1 and 4 weeks after completion of rifampin therapy. Rifampin was administered (10-mg/kg dose; maximum, 600 mg) twice daily for 4 days.. Ten of 21 infants (48%) and 13 (65%) of their 20 mothers were colonized with GBS at throat or rectal (infant) or vaginal, rectal or breast milk (mother) sites before rifampin was initiated. One week or less after rifampin treatment, 7 (70%) infants and 4 (31%) mothers remained colonized with GBS. At study completion 6 infants and 7 mothers had GBS colonization. Persistent colonization was not related to GBS serotype, to initial rifampin minimal inhibitory concentration or to the development of rifampin resistant strains.. Rifampin treatment for four days utilized as a single agent after completion of parenteral therapy failed to reliably eradicate GBS colonization in infants.

Topics: Anti-Bacterial Agents; Humans; Infant, Newborn; Microbial Sensitivity Tests; Mucous Membrane; Rifampin; Streptococcal Infections; Streptococcus agalactiae; Treatment Failure

To determine whether augmented quinolone-based antibacterial prophylaxis in neutropenic patients with cancer reduces infections caused by gram-positive cocci and preserves the protective effect against aerobic gram-negative bacilli.. Open, randomized, controlled, multicenter clinical trial.. Centers participating in the National Cancer Institute of Canada Clinical Trials Group.. 111 eligible and evaluable patients hospitalized for severe neutropenia (neutrophil count < 0.5 x 10(9)/L lasting at least 14 days) who were receiving cytotoxic therapy for acute leukemia or bone marrow autografting.. One of three oral antibacterial prophylactic regimens (norfloxacin, 400 mg every 12 hours; ofloxacin, 400 mg every 12 hours; or ofloxacin, 400 mg, plus rifampin, 300 mg every 12 hours) beginning with cytotoxic therapy.. Incidence and cause of suspected or proven infection.. Microbiologically documented overall infection rates for norfloxacin, ofloxacin, and ofloxacin plus rifampin were 47%, 24%, and 9%, respectively (P < 0.001). Corresponding rates were 24%, 13%, and 3%, respectively for staphylococcal bacteremia (P = 0.03) and, 21%, 3%, and 3%, respectively for streptococcal bacteremia (P < 0.01). The pattern of bacteremia suggested that rifampin played a role in suppressing staphylococcal infection. Both ofloxacin alone and ofloxacin plus rifampin had a clinically significant antistreptococcal effect. Aerobic gram-negative rods were cleared from rectal surveillance cultures in all patients after a median of 5.5 days and caused infection in only one patient (0.9%). The reductions in the number of microbiologically documented infections among ofloxacin recipients and ofloxacin plus rifampin recipients were offset by concomitant increases in the number of unexplained fevers (24% of norfloxacin recipients, 53% of ofloxacin recipients, and 49% of ofloxacin plus rifampin recipients; P = 0.02). No statistically significant difference was found among the treatment arms with respect to the overall incidence of febrile neutropenic episodes as defined for this trial (79% for the norfloxacin group, 82% for the ofloxacin group, and 77% for the ofloxacin plus rifampin group).. Quinolone-based antibacterial chemoprophylaxis protected patients from aerobic gram-negative bacillary infections. Augmentation of the gram-positive activity reduced the incidence of gram-positive infections but did not influence the overall incidence of febrile neutropenic episodes.

Topics: Adult; Aged; Anti-Infective Agents; Antineoplastic Agents; Bacteremia; Colony Count, Microbial; Female; Humans; Male; Middle Aged; Neutropenia; Norfloxacin; Ofloxacin; Rifampin; Staphylococcal Infections; Streptococcal Infections; Treatment Outcome

Therapy to eradicate pharyngeally carried group A streptococci (GAS) has increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients with streptococcal toxic shock syndrome. In this randomized, controlled trial, contacts of patients with GAS infections were screened for pharyngeal GAS colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/[kg.d]; maximum 400 mg) or rifampin (20 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days following completion of therapy, repeated cultures were negative for 13 (38%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%-85%) of 97 cefixime recipients. At 10-14 days after treatment, only 53% of cefixime recipients remained culture-negative. Rates of successful clearance improved with increasing age (P < .01); among 17 adults who received cefixime, the success rate was 94%. Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days of therapy with cefixime may be effective for adults, but further studies are needed.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Drug Administration Schedule; Humans; Pharyngitis; Rifampin; Streptococcal Infections; Streptococcus pyogenes

Topics: Adult; Antifungal Agents; Aspergillosis; Azoles; Candidiasis; Cyclosporine; Drug Interactions; Erythromycin; Female; Humans; Kidney Transplantation; Legionnaires' Disease; Male; Middle Aged; Opportunistic Infections; Postoperative Complications; Rifampin; Streptococcal Infections; Tuberculosis, Pulmonary

After the publication of an uncontrolled trial of nine patients with streptococcus-associated psoriasis who appeared to benefit from a course of oral penicillin or erythromycin with the addition of rifampin in the last 5 days, we wished to confirm or refute the validity of this observation.. Our purpose was to confirm the effectiveness of antibiotics in the treatment of streptococcus-associated psoriasis.. Twenty patients were placed randomly into two groups. One group was given penicillin or erythromycin for 14 days with a placebo added during the last 5 of the 14 days. The other group received the same medication with the addition of rifampin in the last 5 days.. Although all the patients studied met the criteria of the reported preliminary study, we were unable to detect any evidence of improvement in their psoriasis.. There was no apparent benefit for patients with streptococcus-associated psoriasis from a course of oral penicillin or erythromycin with the addition of rifampin in the last 5 days in a 14-day trial.

Topics: Adolescent; Adult; Aged; Child; Drug Therapy, Combination; Erythromycin; Female; Humans; Male; Middle Aged; Penicillin V; Psoriasis; Rifampin; Streptococcal Infections

We previously demonstrated that chronic pharyngeal carriage of group A beta-hemolytic streptococci (GABHS) can be terminated by intramuscular administration of benzathine penicillin plus 4 days of orally administered rifampin. Because an effective oral regimen would be desirable, we compared clindamycin with P + R for treating GABHS carriage. Healthy, symptom-free GABHS carriers were randomly assigned to receive orally administered clindamycin (20 mg/kg per day) three times a day for 10 days or intramuscularly administered benzathine penicillin with oral doses of rifampin (20 mg/kg per day) twice a day for 4 days. Compliance was documented by antibiotic activity in urine. Throat cultures for GABHS were obtained every 3 weeks for up to 9 weeks after treatment. Patients who had positive throat cultures for their original GABHS T type 3 weeks after randomization were crossed over to the other treatment. Treatment success was defined as eradication of the original GABHS T type, with all follow-up cultures negative. Clindamycin eradicated carriage in 24 (92%) of 26 patients; penicillin plus rifampin was effective in 12 (55%) of 22 patients (p less than 0.025). Including patients crossed over 3 weeks after enrollment, clindamycin was effective in 28 (85%) of 33 treatment courses compared with 12 of 22 courses of penicillin plus rifampin (p less than 0.05). We conclude that 10 days of oral clindamycin therapy was significantly more effective than benzathine penicillin plus 4 days of orally administered rifampin for treatment of symptom-free GABHS carriers.

Topics: Administration, Oral; Adolescent; Carrier State; Child; Child, Preschool; Chronic Disease; Clindamycin; Drug Evaluation; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Penicillin G Benzathine; Pharyngitis; Rifampin; Streptococcal Infections; Streptococcus pyogenes

The addition of 5 days of rifampin therapy to a 10- or 14-day course of penicillin or erythromycin therapy has been shown to reduce greatly the rate of chronic streptococcal carriage. The empiric use of rifampin in combination with penicillin or erythromycin in nine of nine patients with streptococcal-associated psoriasis appeared to coincide with a marked improvement in their skin.

Topics: Adult; Carrier State; Child; Child, Preschool; Drug Therapy, Combination; Erythromycin; Female; Humans; Male; Penicillin V; Psoriasis; Rifampin; Skin Diseases, Infectious; Streptococcal Infections

We evaluated the efficacy of rifampin in eradicating chronic pharyngeal carriage of group A streptococci. Carriers were defined as healthy children whose throat cultures showed persistence of group A streptococci 3 weeks after receiving benzathine penicillin G intramuscularly. Subsequent M and T typing of group A streptococcal isolates and limited serologic studies confirmed that enrolled patients were carriers. Thirty-eight carriers (37 completed the study) were randomly assigned to three groups: group 1 (13 patients) received no treatment; group 2 (10) received benzathine penicillin intramuscularly; group 3 (14) received benzathine penicillin intramuscularly plus rifampin orally (10 mg/kg twice a day for eight doses). Throat cultures were obtained every 3 weeks for at least 9 weeks. Group 2 and 3 patients who still had positive cultures 3 weeks after treatment were crossed to the opposite group. Cultures became negative in 93% (13 of 14) of patients in group 3, compared with 23% in group 1 and 30% in group 2 (P less than 0.001 and P less than 0.01, respectively). Including patients crossed over, the penicillin plus rifampin regimen was effective in 17 (89%) of 19 treatment courses and was significantly superior to no therapy or to penicillin alone (P less than 0.0005 and P less than 0.005, respectively). We conclude that rifampin plus benzathine penicillin intramuscularly is an effective regimen for those selected patients in whom eradication of group A streptococcal carriage is judged to be desirable.

Topics: Administration, Oral; Adolescent; Carrier State; Child; Child, Preschool; Drug Therapy, Combination; Follow-Up Studies; Humans; Injections, Intramuscular; Penicillin G; Penicillin G Benzathine; Pharyngitis; Random Allocation; Rifampin; Streptococcal Infections; Streptococcus pyogenes

To improve the bacteriologic and clinical cure rates of streptococcal pharyngitis, 79 children were randomly assigned to receive penicillin V alone for 10 days (39 patients) or penicillin for the same duration and rifampin during the last 4 days of penicillin therapy (40 patients). Eleven patients given penicillin had evidence of bacteriologic failure (including eight with relapse of clinical illness) on repeat cultures done 4 to 7 days after treatment, whereas there were no failures in children given combination therapy (P = 0.0015). All eight symptomatic children improved with penicillin-rifampin therapy and subsequent cultures were negative, whereas three asymptomatic children continued to harbor group A streptococci even after combination therapy. Antibody response by antistreptolysin O or antideoxyribonuclease B assay was seen in 50.6% of patients; the antibody responses in both groups were comparable. These results show that addition of rifampin to the penicillin regimen improves the clinical and bacteriologic cure rates in children with streptococcal pharyngitis.

Topics: Adolescent; Child; Child, Preschool; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Infant; Male; Penicillin V; Pharyngitis; Random Allocation; Recurrence; Rifampin; Serologic Tests; Streptococcal Infections; Streptococcus pyogenes

Streptococcus iniae is a re-emerging bacterial pathogen in freshwater and marine aquaculture worldwide. There are no commercial vaccines available for S. iniae in the United States, and autogenous vaccines are restricted to inactivated whole-cell preparations with limited protection against heterogenous strains. Live-attenuated vaccines (LAV) represent an advantageous alternative to these bacterins, as they induce robust cellular and humoral immunity, and may provide longer lasting protection through less stressful routes of administration. We investigated whether accumulation of mutations in S. iniae by serial passage in the presence of rifampin can generate immunogenic LAV conferring protection against challenge with heterologous wild-type (WT) S. iniae strains in Nile tilapia (Oreochromis niloticus). Three lineages of rifampin-resistant S. iniae strains were generated from three genetically distinct parent strains (n = 9) by multiple passages in increments of Rifamycin SV sodium salt. Growth in liquid media, extent of capsulation, antimicrobial susceptibility, survival in Nile tilapia whole blood, and cytotoxicity in an O. mossambicus endothelial cell line were compared between the passaged and WT strains. Nile tilapia challenges were used to assess strain virulence, generation of anti-S. iniae IgM, and the protection conferred by LAV candidates against virulent S. iniae. Rifampin-resistant strains demonstrated changes in growth rate and cytotoxicity in endothelial cells, as well as significant reductions in whole blood survival (p < 0.05). Selected strains also showed attenuated virulence in the Nile tilapia challenge model, and anti-S. iniae IgM generated against these strains demonstrated cross-reactivity against heterologous bacteria. Immunization by intracoelomic injection induced protection against a virulent WT strain of S. iniae, with relative percent survival up to 95.05%.

Topics: Animals; Bacterial Vaccines; Cell Line; Cichlids; Endothelial Cells; Fish Diseases; Immunoglobulin M; Rifampin; Streptococcal Infections; Streptococcus iniae; Vaccines, Attenuated

Biofilm has recently been highlighted as a complicating feature of necrotizing soft tissue infections (NSTI) caused by Streptococcus pyogenes (i.e., group A Streptococcus [GAS]) contributing to a persistence of bacteria in tissue despite prolonged antibiotic therapy. Here, we assessed the standard treatment of benzylpenicillin and clindamycin with or without rifampin in a tissue-like setting. Antibiotic efficacy was evaluated by CFU determination in a human organotypic skin model infected for 24 or 48 h with GAS strains isolated from NSTI patients. Antibiotic effect was also evaluated by microcalorimetric metabolic assessment in

Topics: Anti-Bacterial Agents; Humans; Rifampin; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes

The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear.. A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012.. Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44).. Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bone Diseases; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Female; Hip Prosthesis; Humans; Joint Diseases; Knee Prosthesis; Levofloxacin; Male; Prognosis; Prosthesis-Related Infections; Recurrence; Retrospective Studies; Rifampin; Streptococcal Infections; Streptococcus; Streptococcus agalactiae; Treatment Failure; Treatment Outcome

We aimed to describe the effectiveness and safety of the moxifloxacin-rifampicin combination in non-staphylococcal Gram-positive orthopedic implant-related infections.. Patients treated with the moxifloxacin-rifampicin combination for an implant-related infection from November 2014 to November 2016 were retrospectively identified from the database of the referral centers for bone and joint infections in Western France.. Twenty-three cases of infection due to Streptococcus spp. (n=12), Cutibacteriumacnes (n=6), and Enterococcus faecalis (n=5) were included. Ten patients with hip prosthesis were included. Infection was polymicrobial in 11 cases. According to the MIC, moxifloxacin was 1.5 to 11.7 times as active as levofloxacin against non-staphylococcal Gram-positive bacteria. We reported an 81.8% success rate, and no severe adverse effect.. The moxifloxacin-rifampicin combination is a valuable alternative for the treatment of non-staphylococcal Gram-positive implant-related infections because of the good activity of moxifloxacin against these bacteria and the potential activity on the biofilm.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Combinations; Enterococcus faecalis; Female; Gram-Positive Bacterial Infections; Hip Prosthesis; Humans; Male; Middle Aged; Moxifloxacin; Propionibacteriaceae; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Streptococcal Infections; 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

To estimate the prevalence of antibiotic resistance in indicator bacteria Escherichia coli and Enterococci isolated from duck faeces in Morogoro Municipality, Tanzania.. Escherichia coli and Enterococcus isolation rates from ducks faeces were 91 and 100% respectively. The prevalence of antibiotic resistance of E. coli and Enterococcus was 70.3 and 42%, respectively. E. coli resistant to four antibiotics were 28 (30.8%) and showed high resistance to ampicillin (81.3), tetracycline (75.8) and trimethoprim-sulphamethoxine (62.3). Multiple antibiotic resistance of Enterococcus were more than 65%. High resistance rates shown by Enterococcus were observed in rifampin (62%), ampicillin (62%) and tetracycline (42%). Almost all farmers (92.3%) left their ducks to scavenge for food around their houses. Antibiotics used in animal treatments were oxytetracyclines, sulfonamides, penicillin dihydrostreptomycin while in humans were tetracycline, ampicillin, and amoxicillin.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Asymptomatic Diseases; Drug Resistance, Multiple, Bacterial; Ducks; Enterococcus; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Poultry; Poultry Diseases; Rifampin; Streptococcal Infections; Tanzania; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success.. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy.. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34).. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

Topics: Aged; Anti-Bacterial Agents; Arthritis, Infectious; beta-Lactams; Biofilms; Debridement; Female; Humans; Internationality; Male; Prognosis; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Salvage Therapy; Streptococcal Infections; Streptococcus agalactiae; Treatment Failure

To investigate the outcomes of treatment of streptococcal periprosthetic joint infection (PJI) involving total knee and hip arthroplasties.. Streptococcal PJI episodes which occurred between January 2009 and December 2015 were identified from clinical databases. Presentation and clinical outcomes for 30 streptococcal PJIs in 30 patients (12 hip and 18 knee arthroplasties) following treatment were evaluated from the medical notes and at review. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. The influence of the biofilm active antibiotic rifampin was also assessed.. The infection was thought to have been acquired haematogenously in 16 patients and peri-operatively in 14. The median follow-up time for successfully treated cases was 39.2 months (12 to 75), whereas failure of the treatment occurred within the first year following treatment on every occasion. The infection-free survival at three years with 12 patients at risk was 59% (95% confidence interval 39% to 75%). Failure of the treatment was observed in ten of 22 PJIs (45%) treated with a two-stage revision arthroplasty, two of six (33%) treated by debridement and prosthesis retention, and in neither of the two PJIs treated with one-stage revision arthroplasty. Streptococcal PJI treated with or without rifampin included in the antibiotic regime showed no difference in treatment outcome (p = 0.175).. The success of treatment of streptococcal PJI in our patient cohort was poor (18 of 30 cases, 59%). New therapeutic approaches for treating streptococcal PJI are needed. Cite this article:

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Combined Modality Therapy; Debridement; Female; Hip Prosthesis; Humans; Kaplan-Meier Estimate; Knee Prosthesis; Male; Middle Aged; Postoperative Period; Prosthesis-Related Infections; Reoperation; Retrospective Studies; Rifampin; Streptococcal Infections; Streptococcus; Treatment Failure

Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known.. We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009.. Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04).. The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis; Arthroplasty, Replacement, Knee; Drug Therapy, Combination; Female; Hip Prosthesis; Humans; Knee Joint; Knee Prosthesis; Levofloxacin; Male; Middle Aged; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Streptococcal Infections; Treatment Outcome

Topics: Clindamycin; Discitis; Drug Hypersensitivity; Drug Substitution; Female; Humans; Levofloxacin; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Radionuclide Imaging; Rifampin; Streptococcal Infections; Streptococcus

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

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

Meningitis is a rare clinical manifestation of invasive group A streptococcal (iGAS) disease. Clinical, microbiological and molecular characteristics of 6 consecutive cases of GAS meningitis treated in Haukeland University Hospital in the period 2004-2009 are described. All 6 patients had a primary upper respiratory tract infection, with subsequent mastoiditis in 5, subdural effusions in 2, and cerebral abscess in 1. Five patients needed surgical treatment (myringotomy, craniotomy or mastoidectomy). All patients were treated with a beta-lactam antibiotic in combination with rifampicin. The course was complicated in all cases, and 1 patient died. Three of the bacterial isolates were of the sequence type emm1.0 and they shared the same superantigen gene profile (speA, speG, speJ, smeZ). The remaining 3 isolates belonged to sequence types emm 3.1, emm6.4 and emm12.0. Deletions in emm genes were observed. This report describes the severe and complicated course of GAS meningitis and its management, often requiring surgical intervention.

Topics: Adolescent; Aged; Anti-Bacterial Agents; Antigens, Bacterial; Bacterial Outer Membrane Proteins; beta-Lactams; Carrier Proteins; Child; Female; Gene Deletion; Humans; Male; Mastoiditis; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Norway; Rifampin; Streptococcal Infections; Streptococcus pyogenes; Superantigens

We retrospectively evaluated 105 patients at the Mayo Clinic between 1970 and 2006 with native valve endocarditis who underwent acute valve surgery. The objective was to determine if outcomes differed based on whether they had received an antibiotic regimen recommended for native valve endocarditis or one for prosthetic valve endocarditis. Fifty-two patients had streptococcal and 53 had staphylococcal infections. Patients with each type of infection were divided into two groups: the first received postoperative monotherapy (with a beta-lactam or vancomycin), and the second received combination therapy (with an aminoglycoside for streptococcal infection, and gentamicin and/or rifampin for staphylococcal infection). The duration and types of antibiotics given pre- and postoperatively, valve cultures results, antibiotic-related adverse events, relapses, and mortality rates within 6 months of surgery were analyzed. Cure rates were similar regardless of the regimen administered. With the small number of patients in each group, a multicenter study with a larger cohort of patients is needed to better define optimal postoperative treatment regimens in this population.

Topics: Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; beta-Lactams; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Retrospective Studies; Rifampin; Staphylococcal Infections; Streptococcal Infections; Treatment Outcome; Vancomycin

Topics: Aged, 80 and over; Anti-Bacterial Agents; Cardiology; Daptomycin; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Endocarditis, Bacterial; Female; Humans; Incidental Findings; Interdisciplinary Communication; Lung Neoplasms; Medical Oncology; Pacemaker, Artificial; Patient Care Team; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Radiography; Referral and Consultation; Rifampin; Streptococcal Infections; Streptococcus sanguis; Thoracic Surgery

To assess the level of antibiotic resistance of viridans streptococci in the oral flora of children with a history of rheumatic fever, receiving long-term monthly intramuscular benzathine penicillin G prophylaxis.. Oral swabs from patients receiving monthly penicillin G prophylaxis for rheumatic fever were cultured and tested for viridans streptococci. The E-test was used to test susceptibility to penicillin G, clindamycin, clarithromycin and rifampin. Findings were compared with samples from healthy children who had not been exposed to antibiotic treatment for at least 2 months.. Twenty-six patients and 20 control children were included in the study. Duration of intramuscular antibiotic treatment ranged from 5 months to 13.5 years. Sixty isolates of viridans streptococci species were obtained, with a similar distribution in the two groups. Intermediate resistance to penicillin (MIC 0.25-2 mg/L) was documented in 10 of the 32 isolates (31.2%) in the study group, and high resistance in none, compared to seven of 28 isolates (25%) with intermediate or high resistance in the control group (p=NS). All isolates in the study group and all but one in the control group were susceptible to clindamycin, and all isolates from both groups were susceptible to rifampin. One isolate (3.1%) in the study group and two (7.1%) in the control group were resistant to clarithromycin.. Monthly Intramuscular penicillin prophylaxis has no effect on the antibiotic susceptibility of viridans streptococci in oral flora in children with a history of rheumatic fever, receiving secondary prophylaxis after rheumatic fever, regardless of the duration of treatment.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibiotics, Antitubercular; Child; Clarithromycin; Clindamycin; Drug Administration Schedule; Drug Resistance, Bacterial; Female; Hospitals, Pediatric; Humans; Israel; Male; Microbial Sensitivity Tests; Mouth; Penicillin G Benzathine; Rheumatic Fever; Rifampin; Secondary Prevention; Streptococcal Infections; Viridans Streptococci

Streptococcus intermedius is increasingly being recognised as an aetiological agent in central nervous system infections. Primary ventriculitis caused by this organism has not been reported so far. We present a case of primary ventriculitis, which resulted in adhesions and multiloculated hydrocephalus, necessitating numerous surgical procedures to control it. No predisposing factor(s) could be identified. Although the organism could not be cultured from CSF, as he was already on antibiotic treatment, it could, however, be identified by 16S rDNA polymerase chain reaction on the CSF sample. It appears important to recognise this condition and to treat it aggressively to prevent complications such as adhesions and multiloculated hydrocephalus.

Topics: Anti-Infective Agents; Cefotaxime; Cerebral Ventricles; Encephalitis; Endoscopy; Glasgow Coma Scale; Humans; Hydrocephalus; Male; Metronidazole; Middle Aged; Rifampin; Streptococcal Infections; Streptococcus intermedius; Tomography, X-Ray Computed

We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales < or =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined.. A retrospective study at the Queen Elizabeth Hospital, Birmingham covering the period April 1996-March 2004 was carried out. Neurosurgical and anti-microbial therapeutic approaches were reviewed. Any evidence of improvement of clinical features and radiological disappearance of brain abscesses were determined.. Outcome was assessed using the Glasgow Outcome Score (GOS) at 3 and 6 months from the time of surgical intervention. Eighteen patients (82%) had a good outcome by 6 months, with an outcome score of 4-5. Thirteen patients resumed normal life despite minor deficits (GOS 5), while a further five patients had moderate disability though remained independent (GOS 4). One patient had a GOS of 3 and there were three deaths (14). The minimum time to radiological resolution of the abscess was within 1 month in six cases (27) These all represented solitary lesions that required a single drainage procedure in conjunction with 4 weeks of intravenous cefotaxime and metronidazole. Ten cases (45%) had resolution within 4 months and a further three cases took at least 6 months from the time of surgery to show radiological clearance.. This cohort of patients responded favourably to the guidelines recommended by the BSAC. This was confirmed by the Glasgow Outcome Score (GOS 4-5) at 6 months review. Cefotaxime at a higher dose with rifampicin was prescribed for patients presenting with a decreased conscious level (GCS 8-11), subsequent failure of anticipated clinical improvement or clinical deterioration. There was no clinically significant difference in GOS between the two treatment groups. An algorithm for management of brain abscess is presented, based on our clinical experience and review of the literature.

Topics: Adolescent; Adult; Aged; Algorithms; Anti-Infective Agents; Brain Abscess; Causality; Cefotaxime; Cohort Studies; Drainage; Female; Glasgow Outcome Scale; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Rifampin; Risk Factors; Streptococcal Infections; Streptococcus milleri Group; Time Factors; Treatment Outcome

Available data from the Southern Reunion Island Medical Group was processed to assess the evolution of Streptococcus pneumoniae resistance to antibiotics since 1994 when the first penicillin-non-susceptible S. pneumoniae (PNSSP) was identified. In addition, 249 strains, isolated between 1998 and 2004, were tested against telithromycin and moxifloxacin.. Between 1994 and 2004, the percentage of PNSSP increased from 0 to 59.2%. Among PNSSP, 13.9% were resistant strains in 2004 with MICs<4 microg/ml. Before 2001 the rate of resistance to penicillin was superior to 50%. In 2004, 15.8 and 8.7% of the isolated strains were of decreased susceptibility to amoxicillin and cefotaxime respectively while none were resistant to either treatment. Other antibiotics followed the pattern of resistance to penicillin. Between 1998 and 2004, resistance to erythromycin decreased from 42.5 to 35.1%, from 35.1 to 22.8% for cyclins, from 18.8 to 8.8 for chloramphenicol, and from 38.3 to 12.3% for cotrimoxazole. All tested strains were susceptible to both telithromycin and moxifloxacin.. Amoxicillin remains efficient for all strains isolated in the Reunion Island in 2004. The presence of strains with decreased susceptibility to third generation cephalosporins implies combination with vancomycin for empirical treatment of pneumococcal meningitis. Moxifloxacin can be used when using a fluoroquinolone is justified. Telithromycin is efficient even on strains resistant to erythromycin and consequently this molecule can be prescribed in the case of a required macrolide treatment.

Topics: Aza Compounds; beta-Lactams; Cephalosporin Resistance; Cephalosporins; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Humans; Ketolides; Moxifloxacin; Penicillin Resistance; Quinolines; Retrospective Studies; Reunion; Rifampin; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of group B streptococcal septicemia of digestive origin with secondary bilateral breast dermal-hypodermal localization.. A 71 year-old woman with a past history of bilateral breast cancer treated by conservation therapy was hospitalized because of the sudden occurrence of two clearly delimited, inflammatory, dermal-hypodermal cutaneous plaques located on each breast, associated with fever (39 degrees C), 4 days after a colonoscopy. Further investigations eliminated carcinomatous mastitis and blood cultures were positive for group B beta-hemolytic streptococcus (Streptococcus agalactiae). Histological examination of a sigmoid polyp revealed a tubular adenocarcinoma.. We report the first documented case of secondary dermal-hypodermal bacterial skin infection (cellulitis) due to group B beta-hemolytic streptococcus. The occurrence after colonoscopy examination, chronology of clinical features, bilaterality and positive blood cultures are arguments in favor of the secondary nature of the skin infection process.

Topics: Adenocarcinoma; Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Breast Diseases; Cellulitis; Clavulanic Acid; Colonic Polyps; Colonoscopy; Drug Therapy, Combination; Female; Humans; Metronidazole; Rifampin; Sepsis; Sigmoid Neoplasms; Streptococcal Infections; Streptococcus agalactiae; Time Factors; Treatment Outcome

Activity of rifampin against 129 Streptococcus mitis isolates obtained from patients with hematologic cancer was investigated. One hundred twenty-five strains were susceptible to rifampin, and 4 were resistant (MIC = 32 to 64 microg/ml). Resistance to rifampin was related to mutations in the rpoB gene: His(526)Asn in three strains and His(526)Asp in one strain.

Topics: Antibiotics, Antitubercular; DNA Primers; DNA-Directed RNA Polymerases; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Mutation; Neutropenia; Rifampin; Sequence Analysis, Protein; Streptococcal Infections; Streptococcus mitis

Topics: Anal Canal; Antibiotics, Antitubercular; Cellulitis; Child; Child, Preschool; Drug Resistance, Bacterial; Genotype; Humans; Male; Microbial Sensitivity Tests; Penicillins; Pharyngitis; Polymerase Chain Reaction; Rifampin; Streptococcal Infections; Streptococcus pyogenes

A preterm breast-fed infant had three episodes of type Ia/c group B streptococcus septicemia. After the second episode rifampin was given to the infant, but further Ia/c exposure to maternal breast milk ensued. We propose rifampin treatment for both the mother and infant in cases of recurrent group B streptococcus disease.

Topics: Breast Feeding; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Infant, Newborn; Leprostatic Agents; Milk, Human; Recurrence; Rifampin; Streptococcal Infections; Streptococcus agalactiae

Topics: Administration, Oral; Adult; Amoxicillin; Animals; Ankle Joint; Arthritis, Infectious; Drug Therapy, Combination; Horses; Humans; Male; Penicillins; Rifampin; Streptococcal Infections

A total of 68 viridans group streptococci, including 31 Streptococcus sanguis, 12 S. mitis, 3 S. salivarius, and 8 S. milleri from blood, and an additional 14 S. milleri from abscesses and normally sterile sites, were tested against penicillin, amoxicillin, cefazolin, ceftriaxone, meropenem, clindamycin, quinupristin/dalfopristin, rifampin, levofloxacin, ofloxacin, vancomycin, and gentamicin with the microdilution method. The susceptibility rates for S. sanguis were: penicillin, 74%; amoxicillin, 84%; ceftriaxone, 94%; clindamycin, 87%, and vancomycin, 100%. The susceptibility rates for S. mitis were: penicillin, 42%; amoxicillin, 67%; ceftriaxone, 58%; clindamycin, 100%; and vancomycin, 100%. The susceptibility rates for S. milleri were: penicillin, 100%, amoxicillin. 100%; ceftriaxone, 100%, clindamycin, 100%; and vancomycin, 100%. Two of the three isolates of S. salivarius were susceptible to penicillin, amoxicillin, and ceftriaxone; all were susceptible to clindamycin and vancomycin. Levofloxacin, quinupristin/dalfopristin, and rifampin were highly active against all isolates.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Clindamycin; Drug Resistance, Microbial; Gentamicins; Humans; Levofloxacin; Meropenem; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Rifampin; Streptococcal Infections; Streptococcus; Thienamycins; Vancomycin; Virginiamycin

Topics: Adult; Cephalothin; Drug Therapy, Combination; Glomerulonephritis, Membranous; Humans; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Piperacillin; Rifampin; Streptococcal Infections; Streptococcus agalactiae

Topics: Anti-Bacterial Agents; Cephalothin; Ciprofloxacin; Clindamycin; Erythromycin; Humans; Microbial Sensitivity Tests; Penicillins; Philadelphia; Rifampin; Streptococcal Infections; Streptococcus pyogenes; Vancomycin

Two toddlers who attended the same day-care center were hospitalized hours apart with sepsis and meningitis due to a multiply resistant Streptococcus pneumoniae. We determined the prevalence of multiply resistant S pneumoniae respiratory carriage and disease in infants, toddlers, and staff in the day-care center and in household contacts. The nasopharynges of 82 (96%) of 85 day-care center children, 26 (90%) of 29 day-care center staff, and 28 (90%) of 31 family members were cultured. Streptococcus pneumoniae grew from 29 (35%) of the 82 cultured day-care center children. Ten (34%) of the S pneumoniae isolates were resistant to sulfamethoxazole-trimethoprim, oxacillin, and tetracycline and were relatively resistant to penicillin (minimum inhibitory concentration, 0.5 mg/L). All were serotype 14 and had the same antibiotic resistance pattern. Treatment of 97% of the day-care center children and staff with rifampin (10 mg/kg twice daily for 2 days) resulted in 70% reduction in positive nasopharyngeal cultures for S pneumoniae. No additional disease due to multiply resistant S pneumoniae was identified in the day-care center during a 9-month follow-up period. This report documents that an outbreak of multiply resistant invasive S pneumoniae occurred in a day-care center setting; that nasopharyngeal colonization of exposed children was common; and that rifampin treatment of 2 days only partially eradicated the organism from colonized individuals.

Topics: Administration, Oral; Carrier State; Child Day Care Centers; Disease Outbreaks; Drug Resistance, Microbial; Humans; Infant; Meningitis, Pneumococcal; Nasopharynx; Prevalence; Rifampin; Sepsis; Streptococcal Infections; Texas

Therapeutic effect of liposomal dosages of rifampicin and prodigiozan was studied on rabbits with simulated chronic tonsillitis in comparison to that of commercial ones of the drugs. The treatment schemes included daily intra-tonsillar++ injections of the dosage forms for 5 days. A high efficacy of their liposomal dosage forms in treatment of experimental chronic tonsillitis was confirmed microbiologically and immunologically. Approval of the liposomal dosage forms used in the therapy of patients with chronic tonsillitis requires clinical trials.

Topics: Adjuvants, Immunologic; Animals; Chronic Disease; Drug Carriers; Drug Evaluation, Preclinical; Drug Therapy, Combination; Liposomes; Palatine Tonsil; Polysaccharides, Bacterial; Prodigiozan; Rabbits; Rifampin; Streptococcal Infections; Tonsillitis

Teicoplanin, a recently introduced glycopeptide antibiotic, has been used, in combination with other antibiotics, to treat 31 episodes of septicaemia caused by Gram-positive organisms. Teicoplanin has double the activity of vancomycin against many Gram-positive bacteria, but allergic reactions and toxicity appear to be infrequent. A single daily dose is sufficient to maintain therapeutic levels, which is an advantage in conditions requiring long-term treatment. Of the 31 episodes treated, 16 were associated with infective endocarditis, 11 with Hickman catheter infection, two with bone and joint infection, and two with infection of other indwelling prosthetic devices. Staphylococcus epidermidis was isolated in 18 infections, of which seven treatment courses were unsuccessful. One death occurred from an uncontrolled infection, three deaths from underlying disease (one of which had relapsed twice), and one after withdrawal of treatment following febrile reaction. Eleven episodes were cured. Six episodes of Staphylococcus aureus septicaemia were treated, of which two failed to respond, two relapsed, one improved and one was cured. The remaining seven episodes were caused by streptococci (including Streptococcus faecalis), and in all of them cure was achieved despite the lack of consistent serum bactericidal activity in vitro.

Topics: Adolescent; Adult; Aged; Aminoglycosides; Enterococcus faecalis; Female; Glycopeptides; Half-Life; Humans; Male; Middle Aged; Rifampin; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Streptococcal Infections; Teicoplanin

Endocarditis caused by nutritionally deficient streptococci has a high bacteriologic and clinical failure rate, despite appropriate antimicrobial therapy. We investigated by time kill curve methodology nine clinical endocarditis isolates of nutritionally deficient streptococci to determine the in vitro efficacies of vancomycin and rifampin alone and in combination. The combination of vancomycin and rifampin demonstrated synergy and bactericidal activity in five of the strains. In one strain, this combination inhibited growth by greater than 2 log10 CFU/ml when compared to the growth control or either antibiotic alone, but it failed to be bactericidal. Indifference, defined as less than or equal to 2 log10 CFU per milliliter increase in killing of the combination compared to the next most active single agent, was demonstrated with the remaining three isolates. Changing the antibiotic concentrations in the time kill curve studies for these latter strains failed to demonstrate synergistic activity of the antibiotic combination. The vancomycin and rifampin combination may be a promising therapeutic modality for which in vivo correlation is indicated.

Topics: Drug Synergism; Endocarditis, Bacterial; Humans; Rifampin; Streptococcal Infections; Streptococcus; Time Factors; Vancomycin

In rats challenged with viridans streptococci poorly susceptible to antibiotic killing, single doses of antibiotics only prevent endocarditis induced by bacterial inoculum sizes that produce disease in 90% of control animals (ID90): additional doses are required to protect against inocula exceeding the ID90. We investigated whether single-dose rifampin would extend the efficacy of single-dose prophylaxis to inocula exceeding the ID90. We used two strains of viridans streptococci highly susceptible to killing by rifampin and two resistant strains. All rats were injected with 10-1,000 times the ID90 of the four strains. Single-dose rifampin successfully prevented endocarditis due to all four strains. A few prophylaxis failures were observed after challenge with the two poorly susceptible strains, but in vivo emergence of resistant variants did not account for these failures. Thus, rifampin was the first antibiotic given as a single dose that successfully prevented experimental streptococcus endocarditis after challenge with high bacterial inocula.

Topics: Adhesiveness; Animals; Blood Platelets; Drug Resistance, Microbial; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Rats; Rats, Inbred Strains; Rifampin; Streptococcal Infections; Streptococcus

We tested the ability of teicoplanin alone and in combination with rifampicin or gentamicin to cure experimental endocarditis and granuloma pouch infections in rats caused by Streptococcus faecalis, Str. sanguis, methicillin-sensitive and -resistant Staphylococcus aureus. Vancomycin and ampicillin were also tested. Teicoplanin was more active than vancomycin and ampicillin. Combinations of teicoplanin with rifampicin or gentamicin were significantly more effective than single drug therapy. These results suggest that teicoplanin could be an interesting alternative to vancomycin in the treatment of serious streptococcal and staphylococcal infections in man.

Topics: Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Glycopeptides; Granuloma; Male; Methicillin; Penicillin Resistance; Rats; Rats, Inbred F344; Rifampin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Teicoplanin; Vancomycin

Topics: Dermatitis; Drug Therapy, Combination; Humans; Ketoconazole; Rifampin; Staphylococcal Infections; Streptococcal Infections

Topics: Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nasopharynx; Recurrence; Rifampin; Streptococcal Infections; Streptococcus agalactiae

Although multiple antibiotic strategies to eradicate group B streptococci (GBS) from colonized infants and women have been utilized, no regimen has been successful in eliminating GBS carriage reliably. Because rifampin has been successful in terminating nasopharyngeal colonization with other bacteria, we tested both the in vitro sensitivity of GBS to rifampin and the in vivo efficacy of rifampin in eliminating GBS from a new animal model of nasally colonized infant rats. The minimal inhibitory concentration of rifampin for 18 clinically derived strains of type III GBS ranged from 0.1 to 0.4 micrograms/ml. Atraumatic nasal inoculation of infant rats with 10(6)-10(7) colony forming units of GBS twice daily for 4 days resulted in heavy asymptomatic carriage for at least 10 days. Colonized animals were divided into four treatment groups: saline, oral rifampin, intraperitoneal penicillin, or oral rifampin plus intraperitoneal penicillin. Treatment was administered every 12 h for 4 days. All 78 saline-treated controls and 47 of 52 (90.4%) penicillin-treated animals had continued GBS carriage 36 h after completion of therapy. In contrast, only 18 of 52 (34.6%) rifampin-treated animals and seven of 54 (13.0%) rifampin plus penicillin-treated animals remained GBS-positive. No rifampin-resistant GBS were detected. Combination rifampin plus penicillin therapy was significantly more effective in terminating GBS carriage compared to saline or penicillin alone (p less than 0.0001) or to rifampin (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Animals, Newborn; Disease Models, Animal; Drug Evaluation, Preclinical; Drug Therapy, Combination; Nasal Mucosa; Penicillins; Rats; Rats, Inbred Strains; Rifampin; Streptococcal Infections; Streptococcus agalactiae

Topics: Drug Therapy, Combination; Humans; Penicillin V; Pharyngitis; Rifampin; Streptococcal Infections

The activities of ampicillin, rifampin, streptomycin, and their combinations were evaluated in vitro against Streptococcus faecalis strain GK and in vivo in rats with an established pyelonephritis resulting from challenge with this same enterococcus. In vitro synergy was demonstrated between all combinations. Comparison of the log colony-forming units of S. faecalis recovered per gram of kidney tissue showed that all treated groups had significant lower numbers than controls (P less than 0.001). Ampicillin plus streptomycin or ampicillin alone was superior to rifampin alone or rifampin plus streptomycin at each interval (P less than 0.001). There was no significant difference between ampicillin and rifampin plus ampicillin. The disparity between in vitro and in vivo results again raises some doubts as to the relevance of in vitro observations to clinical outcome.

Topics: Administration, Oral; Ampicillin; Animals; Drug Therapy, Combination; Enterococcus faecalis; Injections, Intramuscular; Male; Pyelonephritis; Rats; Rats, Inbred Strains; Rifampin; Streptococcal Infections; Streptomycin

Intrathecal vancomycin and oral rifampin have been used together to successfully treat a patient with enterococcal meningitis who was allergic to penicillin and who had failed a course of treatment with chloramphenicol. This therapy was tolerated very well and represents an alternate mode of therapy which should be considered in penicillin allergic patients with enterococcal meningitis.

Topics: Administration, Oral; Chloramphenicol; Drug Hypersensitivity; Drug Therapy, Combination; Humans; Injections, Spinal; Male; Meningitis; Middle Aged; Penicillins; Rifampin; Streptococcal Infections; Vancomycin

Topics: Animals; Bacteria; Bacterial Infections; Bordetella; Drug Evaluation, Preclinical; Enterococcus faecalis; Escherichia coli; In Vitro Techniques; Klebsiella pneumoniae; Listeria monocytogenes; Listeriosis; Mice; Microbial Sensitivity Tests; Pneumococcal Infections; Proteus Infections; Proteus mirabilis; Proteus vulgaris; Pseudomonas aeruginosa; Rifampin; Salmonella typhimurium; Sarcina; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Streptococcus pneumoniae

Topics: Actinomycetales Infections; Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Bacteroides Infections; Cephalosporins; Chloramphenicol; Clindamycin; Clostridium Infections; Erythromycin; Fusobacterium; Humans; Lincomycin; Metronidazole; Microbial Sensitivity Tests; Oxygen; Penicillins; Rifampin; Streptococcal Infections; Tetracycline; Treponemal Infections; Vancomycin; Veillonella

The effectiveness of various antibiotics commonly recommended for the prophylaxis of bacterial endocarditis has been evaluated in experimental streptococcal endocarditis in rabbits. High doses of penicillin G did not prevent the development of this infection. The only consistently successful prophylactic regimens using penicillin alone were those which provided for both an early high serum level and more than 9 h of effective antimicrobial action. Vancomycin was the only other drug which proved uniformly successful when given alone, even though the duration of its antimicrobial action in the blood was only 3 h. However, combined therapy using penicillin G or ampicillin with streptomycin was always effective in prophylaxis. Treatment with single injections of ampicillin, cephaloridine, cephalexin, clindamycin, cotrimoxazole, rifampicin, streptomycin, erythromycin, and tetracycline failed to prevent infection. The findings provide information on the effect of antimicrobials in vivo and may be applicable to the chemoprophylaxis of infective endocarditis in clinical practice.

Topics: Ampicillin; Animals; Cephaloridine; Clindamycin; Endocarditis, Bacterial; Erythromycin; Female; Male; Penicillin G; Rabbits; Rifampin; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Chloramphenicol; Chlortetracycline; Dihydrostreptomycin Sulfate; Drug Stability; Erythromycin; Gastric Juice; Hydrogen-Ion Concentration; Kanamycin; Male; Mice; Microbial Sensitivity Tests; Novobiocin; Penicillin Resistance; Penicillins; Pneumococcal Infections; Rifampin; Solutions; Staphylococcal Infections; Staphylococcus; Streptococcal Infections

Topics: Animals; Cattle; Drug Resistance, Microbial; Female; Injections; Mammary Glands, Animal; Mastitis, Bovine; Milk; Rifampin; Staphylococcal Infections; Streptococcal Infections

Topics: Bronchial Diseases; Chloramphenicol; Humans; Lung Diseases; Microbial Sensitivity Tests; Pseudomonas Infections; Rifampin; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Escherichia coli; Heart Transplantation; Humans; Infection Control; Isoniazid; Male; Penicillin G; Proteus; Rifampin; Streptococcal Infections; Streptomycin; Transplantation; Tuberculosis, Pulmonary

Topics: Animals; Dermatomycoses; Drug Resistance, Microbial; Enterobacteriaceae Infections; Guinea Pigs; Humans; Male; Microbial Sensitivity Tests; Prostatitis; Pyoderma; Rabbits; Rats; Rifampin; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections; Urethritis; Urinary Tract Infections

Topics: Animals; Bacteria; Drug Resistance, Microbial; Humans; Rifampin; Streptococcal Infections

Topics: Animals; Endometritis; Female; Horse Diseases; Horses; Rifampin; Streptococcal Infections

Topics: Animals; Blood; Humans; In Vitro Techniques; Mice; Pneumococcal Infections; Rifampin; Staphylococcal Infections; Streptococcal Infections; Urine