ro13-9904 and Erythema

Unlike most bacterial infections, where diagnosis is by identification of the causal organism, diagnosis of infection by Borrelia burgdorferi (Lyme's borreliosis) relies mostly upon indirect techniques. This situation has some short-comings. As long as no technology permits a microbiological diagnosis of this infection, controversy will exist as to the clinical symptoms and the criteria for the cure of the disease. Despite the lack of consensus upon both the clinical definition and the treatment of Lyme's borreliosis, it is widely agreed that the affection is best understood if regarded as a progressive general infectious disease. Indeed, following a bite with local infection, there occurs a fairly rapid dissemination of the spirochaetes. In vivo therapeutic trials have shown the potential effectiveness of beta-lactams and tetracyclines, but no treatment is considered universally effective. Most of the first trials were empirical, as antibiograms were not used. Antibiotic concentrations reached with some oral therapies are too low for the protection of certain sites such as the central nervous system. In vitro studies conducted on various strains of B. burgdorferi both in the US and in Europe are very enlightening. Among the more perplexing results of some of these studies, it is worth noting the high resistance rate of some B. burgdorferi strains to penicillin, reported by Johnson et al. and by Preac Mursic et al. Therapy for Lyme's borreliosis is discussed in light of both the in vivo and in vitro studies.

Topics: Borrelia; Borrelia Infections; Ceftriaxone; Central Nervous System Diseases; Clinical Trials as Topic; Erythema; Humans; Lyme Disease; Penicillins; Random Allocation; Tetracyclines

Topics: Arthritis, Infectious; Ceftriaxone; Drug Administration Schedule; Erythema; Humans; Lyme Disease; Nervous System Diseases; Penicillins; Skin Diseases; Tetracycline

The aim of this study was to determine the efficacy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG).. An open prospective, randomised, multicenter study was conducted in 141 patients; 72 received ceftriaxone 1 g i.v. 30 min preintervention, and 69 received no study medication. A standardized protocol was followed for PEG preparation, insertion, and aftercare; all patients received a 15-Fr gastrostomy tube. Follow-up of local and systemic infection and clinical course was continued to postintervention day 10. An aggregate erythema and exudation score >3 or the presence of pus was taken as indicative of peristomal infection. The pharmacoeconomics of antibiotic use were also examined.. In no-prophylaxis patients, wound infection rates were 25% on day 4 and 26.4% on day 10, versus 10.1% (p = 0.03) and 14.5% (p = 0.10), respectively, in prophylaxis patients. Results were disproportionally better in tumor patients: systemic infection rates were 16.7% versus 5.8% in no-prophylaxis versus prophylaxis patients (p = 0.045), and overall infection rates 38.9% versus 17.4%, respectively (p = 0.046). Pneumonia was more frequent in patients with underlying neurological disease. Antibiotic costs were the same in both groups (p = 0.792).. Single dose ceftriaxone 1 g is an effective prophylaxis against local and systemic infection after PEG.

Topics: Aged; Antibiotic Prophylaxis; Bacteremia; Ceftriaxone; Cephalosporins; Drug Costs; Economics, Pharmaceutical; Enteral Nutrition; Erythema; Exudates and Transudates; Female; Follow-Up Studies; Gastroscopy; Gastrostomy; Humans; Male; Neoplasms; Nervous System Diseases; Pneumonia; Prospective Studies; Sepsis; Suppuration; Surgical Wound Infection

Unlike most bacterial infections, where diagnosis is by identification of the causal organism, diagnosis of infection by Borrelia burgdorferi (Lyme's borreliosis) relies mostly upon indirect techniques. This situation has some short-comings. As long as no technology permits a microbiological diagnosis of this infection, controversy will exist as to the clinical symptoms and the criteria for the cure of the disease. Despite the lack of consensus upon both the clinical definition and the treatment of Lyme's borreliosis, it is widely agreed that the affection is best understood if regarded as a progressive general infectious disease. Indeed, following a bite with local infection, there occurs a fairly rapid dissemination of the spirochaetes. In vivo therapeutic trials have shown the potential effectiveness of beta-lactams and tetracyclines, but no treatment is considered universally effective. Most of the first trials were empirical, as antibiograms were not used. Antibiotic concentrations reached with some oral therapies are too low for the protection of certain sites such as the central nervous system. In vitro studies conducted on various strains of B. burgdorferi both in the US and in Europe are very enlightening. Among the more perplexing results of some of these studies, it is worth noting the high resistance rate of some B. burgdorferi strains to penicillin, reported by Johnson et al. and by Preac Mursic et al. Therapy for Lyme's borreliosis is discussed in light of both the in vivo and in vitro studies.

Topics: Borrelia; Borrelia Infections; Ceftriaxone; Central Nervous System Diseases; Clinical Trials as Topic; Erythema; Humans; Lyme Disease; Penicillins; Random Allocation; Tetracyclines

Topics: Anti-Bacterial Agents; Ceftriaxone; Erythema; Humans; Immune Reconstitution Inflammatory Syndrome; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Subacute Bacterial; Erythema; Gentamicins; Humans; Male; Purpura; Treatment Outcome; Vancomycin; Young Adult

Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent.

Topics: Acute Generalized Exanthematous Pustulosis; Aged; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Chronic Disease; Clindamycin; Erythema; Female; Fluid Therapy; Humans; Hypotension; Lower Extremity; Lymphedema; Multiple Organ Failure; Obesity, Morbid; Vancomycin; Vasoconstrictor Agents

Mycoplasma pneumonia is responsible for multisystemic infection. Pulmonary symptoms are most common in children. We describe herein two unusual severe forms of M. pneumoniae infection without initial pulmonary symptoms. The first case is an 8-month-old boy who was hospitalized in the pediatric intensive care unit with severe sepsis. There were no initial pulmonary symptoms, nor obvious clinical infection. Initial blood tests and x-ray did not aid the diagnosis. The blood tests came back positive for M. pneumonia. Pulmonary symptoms eventually appeared 24h later, and there was a pneumonia outbreak on the chest radiograph. The boy was given josamycin and improved quickly. The second case concerns an 8-year-old child who was hospitalized in the pediatric intensive care unit with toxic shock. No clinical infectious origin was found. A broad-spectrum antibiotic therapy was started with ceftriaxone and josamycin. The M. pneumoniae blood test came back positive, which confirmed the diagnosis of septic shock in M. pneumoniae, requiring adjustment of the antibiotic therapy. Current guidelines for the choice of probabilistic antibiotic therapy in case of severe sepsis do not include the case of M. pneumoniae. The early initiation of antibiotic therapy plays a major role in the prognosis of these patients. It seems useful to search for M. pneumoniae in cases of severe atypical infections, particularly in the absence of pulmonary symptoms.

Topics: Anti-Bacterial Agents; Ceftriaxone; Erythema; Female; Fever; Humans; Infant; Josamycin; Male; Mycoplasma pneumoniae; Natriuretic Peptide, Brain; Pneumonia, Mycoplasma; Sepsis; Severity of Illness Index; Tachycardia

Liquid injectable silicone has been used to increase volume in determined cutaneous districts, particularly in aesthetical reconstructive surgery. Although considered biologically inert for a long time this substance produced various complications as granulomatous foreign body reaction (siliconomas), secondary limphedema, tissue destruction and lethal embolism. A 35-year-old Caucasian woman came to our department with erithema and edema on the right leg, fever and chills. A thorough examination of the patient's history revealed injection of liquid silicone 7 years before for cosmetic volume increase of both legs. A closer observation revealed a small fistulous element from which came out white-yellow puruloid material. Antibiotic therapy and drainage of the abscess were undertaken. Within few days of treatment erithema and swelling essentially improved and the patient was discharged. After two months she came back to our department due to the same disease on her left leg that we treated with the therapy previously used. We highlight the long time, 7 years, elapsed between liquid silicone injection and onset of cutaneous symptoms.

Topics: Abscess; Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Ceftriaxone; Cosmetic Techniques; Cutaneous Fistula; Drainage; Drug Therapy, Combination; Edema; Erythema; Female; Humans; Injections, Subcutaneous; Leg Injuries; Rifamycins; Silicones; Streptococcal Infections; Streptococcus agalactiae; Time Factors; Wound Infection

Topics: Aged; Anti-Infective Agents, Local; Ceftriaxone; Erythema; Female; Fever; Humans; Minocycline; Ofloxacin; Povidone-Iodine; Rickettsia Infections; Severity of Illness Index; Treatment Outcome

New Medical Letter recommendations for prophylaxis and treatment.

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Cefuroxime; Erythema; Humans; Injections, Intravenous; Lyme Disease

Erythema migrans is the characteristic exanthem of Lyme disease. The rash initially occurs at the site of inoculation; subsequently satellite lesions can occur. We describe an adolescent girl in whom the rash appeared after the initiation of ceftriaxone therapy for aseptic meningitis. We suggest that the occurrence of rash in this patient was a result of liberated toxin from local bacterial lysis.

Topics: Adolescent; Borrelia burgdorferi; Ceftriaxone; Cephalosporins; Erythema; Female; Humans; Lyme Disease; Meningitis, Aseptic

Between June 1981 and July 1987 the efficacy of antibiotic treatment of 215 patients with erythema chronicum migrans of Lyme disease was evaluated in terms of the necessity for retreatment and the prevention of the late manifestations of Lyme disease. The principal antibiotics utilized to treat 161 patients through 1986 were varying doses of tetracycline, or penicillin alone or in combination with probenecid. Two of 80 patients with a minor form of the illness and 17 of 81 patients with a major form of the illness required retreatment. There were four patients who did not respond to retreatment with their original medication. A 15- to 30-day course of amoxicillin (500 mg q.i.d.) and probenecid (500 mg q.i.d.) or doxycycline (100 mg t.i.d.), and on three occasions ceftriaxone (2-4 g/day i.v.), were used to treat 54 patients in 1987. Although it is too early to judge the efficacy of treatment in these patients, increases in the incidence of Herxheimer reactions and drug eruptions were observed. Strict compliance with treatment protocols and the possibility of reactions to medications should be thoroughly discussed with patients.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Child; Chronic Disease; Erythema; Female; Humans; Lyme Disease; Penicillins; Pregnancy; Tetracyclines