sultamicillin and Osteomyelitis

Sulbactam (SB) and clavulanic acid (CA) are irreversible inhibitors of the beta-lactamases in the Richmond and Sykes classes II-VI. When combined with ampicillin and ticarcillin, SB and CA, respectively, extend the spectrum of activity of these penicillins to include some beta-lactamase-producing aerobes (Enterobacteriaceae, Hemophilus influenzae, staphylococci) and anaerobes (Bacteroides fragilis group) which would otherwise be resistant. Neither effectively inhibits the class I beta-lactamases frequently produced by Pseudomonas aeruginosa, Enterobacter, and Serratia, in part explaining the resistance observed with these organisms. Clinically, both agents were as effective as the comparative therapies in all but two of the trials reviewed. Given the current data, the decision to add these agents to the formulary should be based on hospital resistance patterns and on the cost of these antimicrobials in comparison to conventional therapies.

Topics: Ampicillin; Arthritis, Infectious; Bacterial Infections; Bacteroides fragilis; beta-Lactamase Inhibitors; Clavulanic Acids; Clinical Trials as Topic; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacteriaceae; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Osteomyelitis; Pelvic Inflammatory Disease; Respiratory Tract Infections; Sulbactam; Ticarcillin

In a prospective study 105 children hospitalized with soft tissue infection, 11 children with suppurative arthritis and 9 children with osteomyelitis were treated with either parenterally administered ampicillin/sulbactam or ceftriaxone. Treatment was randomized using a computer-generated table in a 2:1 fashion: 84 patients received ampicillin/sulbactam and 41 patients received ceftriaxone. Organisms isolated from wound site or blood cultures included Staphylococcus aureus (33), Streptococcus pyogenes (19), Haemophilus influenzae (9) including 4 beta-lactamase-positive organisms, Streptococcus pneumoniae (5), Neisseria gonorrhoeae (3) and 9 other organisms. Clinical and bacteriologic response was satisfactory in 100% of the ampicillin/sulbactam-treated patients and in 93% of the ceftriaxone-treated patients. Two patients with S. aureus infections treated with ceftriaxone had a delayed response and required change in therapy to parenterally administered oxacillin. Ampicillin/sulbactam represents a potentially useful single agent for the treatment of cellulitis and bone or joint infections in pediatric patients.

Topics: Acinetobacter Infections; Adolescent; Ampicillin; Arthritis, Infectious; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gonorrhea; Haemophilus Infections; Humans; Infant; Male; Osteomyelitis; Prospective Studies; Random Allocation; Staphylococcal Infections; Streptococcal Infections; Sulbactam

Lemierre syndrome is a clinical syndrome that presents with internal jugular thrombophlebitis, septicemia and systemic abscess formations. In general, the condition is preceded by oropharyngeal infections. We report a case of a 73-year-old man with Lemierre syndrome, clivus osteomyelitis and a steroid-responsive mass in the cavernous sinus-suprasellar region. He complained of fever, occipital pain, diplopia and right ptosis. Administration of oral steroids ameliorated the ophthalmic symptoms for a period before he was admitted to our hospital. After admission, the severity of his headache advanced, and his ophthalmic symptoms progressed bilaterally. Brain magnetic resonance imaging showed contrast enhancement of the clivus and revealed a mass lesion contrast-enhancement effect in the cavernous sinus-suprasellar region. Fusobacterium nucleatum was detected by blood culture, and computed tomography revealed multiple bacterial emboli in both lung fields and thrombosis of the left internal jugular vein; thus, he was diagnosed with Lemierre syndrome. After venous administration of antibiotics, his fever and headache markedly improved, but the ophthalmic symptoms did not. We prescribed an oral steroid because the cavernous sinus-suprasellar lesion was probably an inflammatory granuloma caused by a para-infectious mechanism rather than by infection. After the series of treatments, his ophthalmic symptoms improved, and the cavernous sinus-suprasellar region mass lesion decreased. He was eventually discharged in a fully ambulatory state and had no ophthalmic difficulties. We thought that the osteomyelitis of clivus was caused by Lemierre syndrome and its inflammatory processes formed the granuloma in the cavernous sinus-suprasellar region. This was a case of Lemierre syndrome with a rare combination of clivus osteomyelitis and a steroid-responsive tumour in the cavernous sinus-suprasellar region that was successfully treated.

Topics: Administration, Oral; Aged; Ampicillin; Anti-Bacterial Agents; Cavernous Sinus; Cranial Fossa, Posterior; Drug Therapy, Combination; Fusobacterium nucleatum; Glucocorticoids; Granuloma; Humans; Infusions, Intravenous; Lemierre Syndrome; Magnetic Resonance Imaging; Male; Osteomyelitis; Prednisolone; Sulbactam; Tomography, X-Ray Computed; Treatment Outcome; Vascular Diseases

Topics: Adenoids; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Cellulitis; Child, Preschool; Clindamycin; Cranial Fossa, Posterior; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever; Humans; Lymphadenitis; Magnetic Resonance Imaging; Neck Pain; Occipital Bone; Osteomyelitis; Pharyngitis; Skull Neoplasms; Sulbactam; Tomography, X-Ray Computed

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Frontal Bone; Frontal Sinusitis; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Sulbactam

In this study the construction and in vivo testing of antibiotic-loaded polyhydroxyalkanoate rods were planned for use in the treatment of implant-related osteomyelitis. The rods were constructed of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) and poly(3-hydroxybutyrate-co-4-hydroxybutyrate), carrying 50% (w/w) Sulperazone or Duocid. They were implanted in rabbit tibia in which implant-related osteomyelitis (IRO) had been induced with Staphylococcus aureus. The effectiveness of the antibiotics in the treatment of IRO was determined. The establishment of IRO with bacterial inoculation was complete after 3 weeks with 100% infection rate in all groups. There was no contamination or super-infection. Both antibiotics were found to be highly effective against the bacteria. Following the application of Sulperazone-P(3-HB-co-4-HB) rods, no infective agents could be isolated from the infection site within the 6-week test period, indicating complete treatment of the infection. Macroscopical evaluation at follow-up revealed no drainage, minimal swelling and increase in local warmth, most probably due to the surgery rather than to a reaction towards the implant. The overall scores for radiological findings by the end of 6 weeks were 0.8/5 for the antibiotic-loaded rod implanted in the right limb, and 1.1/5 for the antibiotic-free rod implanted in the left limb. There was no statistical difference between the antibiotic-loaded and antibiotic-free polymeric rods. In vivo drug release was almost complete within the first week. One interesting observation, however, was that the therapy was still very effective even when the release rate was very high. In the SEM of in vitro tested rods, the polymeric component was unchanged in 2 weeks while the drug leached out, leaving voids behind. In vivo, however, the morphology of the implant was significantly modified within 6 weeks post-implantation. Since a substantial degree of the in vivo drug release was complete within 1 week, we believe that dissolution of the drug must be the predominant mechanism through which the drug release is controlled.

Topics: Absorbable Implants; Ampicillin; Animals; Cefoperazone; Drug Carriers; Drug Combinations; Humans; Hydroxybutyrates; Osteomyelitis; Polyesters; Prostheses and Implants; Prosthesis Implantation; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Sulbactam; Tibia

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine that affects the various developmental steps of hematopoietic cells and enhances the phagocytic activity of these cells. The effect of GM-CSF on acute osteomyelitis, developed in rats, was investigated. For this purpose, osteomyelitis was firstly developed through the direct inoculation of Staphylococcus aureus into rat tibial metaphysis. Twenty-four rats in which diagnosis of osteomyelitis was histopathologically established were divided into two groups. Antibiotic only was given to the first group, and antibiotic as well as GM-CSF to the second group. Rats were followed up for 3 months with plain radiographs and scintigraphic methods using 67Ga-citrate. Material obtained from the rats that had been killed at the end of the 3rd month were histopathologically investigated. One rat in the first group died. In another rat, chronic osteomyelitis developed and fracture was observed. In 12 rats of the second group, physical examination, plain radiographs, and histopathologic findings were normal. In scintigraphic studies with 67Ga-citrate, when the pre- and posttreatment value of the same groups were evaluated by the Mann-Whitney U-test, the mean values at 48 h after treatment were found to be significant (P < 0.05), indicating a decrease in the 2nd group (experimental group). In conclusion, the antibiotics were effective in the elimination of infection only together with neutrophils. In this manner, infections may be eliminated by strengthening the host's defense mechanism as well as by administering antibiotics. We believe that an adequate number of long-term studies will shed light on this issue. Besides we consider that this factor will be more important in the study of chronic osteomyelitis.

Topics: Acute Disease; Ampicillin; Animals; Biopsy, Needle; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Therapy, Combination; Granulocyte-Macrophage Colony-Stimulating Factor; Injections, Intramuscular; Osteomyelitis; Radionuclide Imaging; Rats; Rats, Sprague-Dawley; Sensitivity and Specificity; Staphylococcus aureus; Sulbactam; Treatment Outcome

Various random copolyesters of 3-hydroxybutyrate and 3-hydroxyvalerate (PHBV) and 3-hydroxybutyrate and 4-hydroxybutyrate P(3HB-4HB) were used in the construction of biodegradable, implantable rods for the local delivery of antibiotics (Sulperazone and Duocid) in chronic osteomyelitis therapy. Drug loading, type of active agent, and additional coating of the implant surface all have significant contributions to the in vitro release profile. The rate and duration of Sulperazone release from P(3HB-4HB) rods were controlled by the polymer/drug ratio (drug loading). The rate of drug dissolution was substantially higher than that of polymer degradation. Therefore, the release phenomenon was more dependent on drug dissolution rather than on polymer degradation or diffusion. Coating rods with the same type of polymer substantially reduced the initial burst effect observed with the uncoated rods, and significantly decreased the release rate so that the release kinetics became almost zero order. Antibiotic release from coated rods was sustained for over a period of 2 weeks at a constant rate, whereas uncoated rods released their contents in less than a week. Impregnation of Duocid into the hydrophobic polymer matrix yielded a rod with a smoother surface topography. The release from these rods was significantly higher than for rods loaded with Sulperazone and a zero order release could not be obtained with these samples.

Topics: Ampicillin; Anti-Bacterial Agents; Biocompatible Materials; Cefoperazone; Drug Combinations; Drug Implants; Humans; Hydroxybutyrates; In Vitro Techniques; Materials Testing; Microscopy, Electron, Scanning; Osteomyelitis; Polyesters; Sulbactam