s-1108 and Acute-Disease

A 41-year-old woman took an EVE-A tablet, which contained ibuprofen, because of pyrexia over 39 degrees C. Due to continued pyrexia, she visited a physician and received cefcapene and acetaminophen under a diagnosis of cold. However, next day, she was admitted to our hospital with severe hypoxemia and pulmonary infiltrates on chest radiograph. Analysis of bronchoalveolar lavage fluid disclosed an increased proportion of 66% eosinophils. All of the lymphocyte stimulation tests for EVE-A tablet, cefcapene and acetaminophen showed positive. After the cessation of these drugs, she was successfully treated with steroids. This case was diagnosed as eosinophilic pneumonia caused by several drugs, and to our knowledge, this is the first report in Japan of ibuprofen (EVE-A tablet)-induced pneumonia.

Topics: Acetaminophen; Acute Disease; Adult; Analgesics, Non-Narcotic; Cephalosporins; Humans; Ibuprofen; Lymphocyte Activation; Male; Methylprednisolone; Prednisolone; Pulmonary Eosinophilia; Tablets; Treatment Outcome

Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community.. The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients).. In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10(9)/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups.. The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.

Topics: Acute Disease; Adult; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; C-Reactive Protein; Cephalosporins; Clarithromycin; Fever; Humans; Japan; Leukocyte Count; Middle Aged; Outpatient Clinics, Hospital; Practice Patterns, Physicians'; Respiratory Tract Infections; Treatment Outcome

Osteomyelitis is an infection in a bone. Acute osteomyelitis is observed mainly in the long leg bones of children and is usually treated with antibiotics. On the other hand, in adults, subacute or chronic osteomyelitis is more common. Antibiotics therapy is not necessarily effective for chronic osteomyelitis, and sometimes a surgical operation is performed for its remission. Furthermore, in classification of osteomyelitis by cause, type 2 diabetes mellitus is one of most common conditions associated with osteomyelitis. It isCase presentation well known that a variety of complications are induced in patients with type 2 diabetes mellitus due to chronic hyperglycemia, inflammatory reaction, and immunodeficiency, especially when glycemic control is poor.. A 58-year-old Japanese man had acute exacerbation of chronic osteomyelitis triggered by aggravation of type 2 diabetes mellitus. He had acute osteomyelitis in his right lower leg in his babyhood. After this episode, he did not experience any pain in his leg for approximately 50 years; he felt acute pain in his right lower leg at the age of 50 when his glycemic control was very poor. He then started undergoing medical therapy for type 2 diabetes mellitus and, after an improvement in glycemic control, his pain was gradually mitigated. However, he did not take medicine for approximately 8 months at the age of 58. After the interruption, glycemic control became very poor and he felt the similar acute pain again in the same area. After improving glycemic control, his pain was gradually mitigated again as observed at the age of 50.. Here we report a case of chronic osteomyelitis under poorly controlled diabetic conditions. Interestingly, chronic osteomyelitis was observed at the same position where acute osteomyelitis was observed in his babyhood. In addition, chronic osteomyelitis was repeatedly observed, and it seemed that its acute exacerbation was closely associated with aggravation of type 2 diabetes mellitus. We should bear in mind that type 2 diabetes mellitus is one of the major risk factors of osteomyelitis and that acute exacerbation of chronic osteomyelitis could be triggered by a disturbance of glycemic control in patients with type 2 diabetes mellitus.

Topics: Acute Disease; Blood Glucose; Cephalosporins; Chronic Disease; Diabetes Mellitus, Type 2; Humans; Hyperglycemia; Hypoglycemic Agents; Inflammation; Insulin; Leg; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis