trimethoprim--sulfamethoxazole-drug-combination and Abdominal-Pain

The aim of the study was to investigate whether recurrent abdominal pain (RAP) in Blastocystis hominis-positive children can be treated successfully with trimethoprim-sulfamethoxazole (TMP/SMX).. From October 2004 to December 2008, all of the patients referred to the Division of Gastroenterology and Nutrition of the University Children's Hospital Zurich because of RAP and detection of B hominis in stool samples as the only pathological finding after a standard workup were offered to participate in the study. Patients were randomly assigned into 2 groups. TMP/SMX or placebo was given for 7 days in a double-blind, placebo-controlled manner. Pain index (PI) was measured with a visual analogue scale. Two weeks after completion of treatment, 3 stool samples were collected and patients were followed clinically. If B hominis was still present, metronidazole was given for 7 days.. Forty patients were included; 37 finished the study (TMP/SMX n = 20, placebo n = 17). Mean PI declined from 7.1 to 3.6 for all of the patients, with a decrease from 6.9 to 4.1 in the TMP/SMX and 7.4 to 3.0 in the placebo group, irrespective of detection of B hominis after treatment. There was no statistically significant difference in PI reduction between the 2 groups. Metronidazole treatment led to a further PI decline from 3.7 to 1.9. Eradication rates were 35% (TMP/SMX) and 44% (metronidazole), compared with spontaneous clearance of 29% in the placebo group.. There is no advantage for TPM/SMX over placebo in the treatment of RAP in B hominis-positive children.

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Blastocystis hominis; Blastocystis Infections; Child; Child, Preschool; Double-Blind Method; Feces; Female; Humans; Male; Metronidazole; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

This study evaluates the safety and potential pharmacokinetic interaction between indinavir and trimethoprim/sulfamethoxazole (TMP/SMZ). In a randomized, three-period crossover fashion, 12 healthy adults received 1 week of indinavir sulfate 400 mg orally every 6 hours with placebo, TMP 160 mg/SMZ 800 mg orally every 12 hours with placebo, and indinavir sulfate with TMP/SMZ. Plasma indinavir, SMZ, and TMP concentrations were determined after the last dose of each treatment period. Concomitant administration resulted in a 17% decrease in geometric mean trough plasma indinavir concentrations (p = 0.032), an 18% increase in geometric mean AUC0-12 h and Cmax TMP values (p = 0.031 and 0.030, respectively), and a 5% increase in geometric mean AUC0-12 h SMZ values (p = 0.039). None of these effects was considered clinically significant. The combination of indinavir sulfate and TMP/SMZ is generally well tolerated, with no clinically significant pharmacokinetic interaction being noted.

Topics: Abdominal Pain; Administration, Oral; Adolescent; Adult; Anti-Infective Agents; Area Under Curve; Bilirubin; Cross-Over Studies; Diarrhea; Drug Interactions; Female; Headache; HIV Protease Inhibitors; Humans; Indinavir; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Pain; Administration, Oral; Amylases; Cells, Cultured; Child; Drug-Related Side Effects and Adverse Reactions; Edema; Enzyme-Linked Immunospot Assay; Female; Humans; Immunization; Lipase; Lymphocyte Activation; Pancreatitis; T-Lymphocytes, Cytotoxic; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting; Withholding Treatment

Melioidosis, the disease caused by Burkholderia pseudomallei is endemic in the Northeastern part of Thailand, South-East Asia, and Northern Australia. The pelvic involvement of disease is rare even in an endemic area. Therefore, we describe in this report the clinical presentation, management, and outcome of the patient with primary tubo-ovarian abscess due to melioidosis.. A 31-year-old Thai cassava farmer woman presented with fever and abdominal pain at left lower quadrant for one month. She also had pain, swelling, and redness of the genitalia without any ulcer. She had odorless whitish vaginal discharge. The pelvic examination revealed excitation pain on the left side of her cervix. Transvaginal ultrasonography revealed a large left tubo-ovarian abscess size 9.4 × 4.8 cm located at anterior of the uterus. Urgent exploratory laparotomy revealed left hydrosalpinx with a large amount of pus. The pus culture grew Burkholderia pseudomallei. The computer tomography of the abdomen revealed multiple hepatosplenic abscesses. The patient underwent left salpingo-oophorectomy and pus drainage. The pathological examination of excised left adnexa revealed chronic and acute suppurative inflammation with necrotic tissue. She was given intravenous ceftazidime for one month, and her clinical symptom improved. She was diagnosed with type 2 diabetes mellitus at this visit and treated with insulin injection. She continued to take oral co-trimoxazole for 20 weeks. The final diagnosis was disseminated melioidosis with left tubo-ovarian abscess and hepatosplenic abscesses in a newly diagnosed morbidly obese diabetic patient.. Burkholderia pseudomallei should be considered as the causative organism of gynecologic infection among patient with risk factor resided in an endemic area who do not respond to standard antibiotics. The pus culture from the site of infection is the only diagnostic method of pelvic melioidosis, appropriate antibiotics, and adequate surgical drainage were the components of the successful outcome.

Topics: Abdominal Abscess; Abdominal Pain; Adult; Anti-Bacterial Agents; Australia; Burkholderia pseudomallei; Ceftazidime; Diabetes Mellitus, Type 2; Female; Humans; Melioidosis; Obesity, Morbid; Suppuration; Thailand; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease is a chronic, rare, multisystemic, infectious entity, described for the first time in 1907. Its aetiological agent is the Gram-negative rod,

Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Arthralgia; Biopsy; Ceftriaxone; Diarrhea; Duodenum; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.. A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.. Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Topics: Abdominal Pain; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Drug Resistance, Bacterial; Female; Gentamicins; Guillain-Barre Syndrome; Humans; Injections, Intravenous; Liver Abscess; Melioidosis; Meropenem; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Splenic Diseases; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to present three cystoisosporiasis cases diagnosed in pediatric patients of the Yuzuncu Yil University Medical Faculty. In the study, stool samples of the patients were evaluated by native-Lugol and modified acid-fast staining methods in the Parasitology Laboratory. The first case was a 4-year-old male child diagnosed with acute lymphoblastic leukemia (ALL). It was reported that the patient had abdominal pain, and permanent bloody and mucous diarrhea (8-10 times a day) was present for almost 1 week after the beginning of ALL treatment. The second case was a 10-year-old boy diagnosed with depression. The patient was brought to our hospital by his parents with complaints of abdominal pain, diarrhea, lack of appetite, weight loss, and fatigue persisting since 1 month in addition to headache, fear, sleeplessness, and waking up with cry. The third case was a 13-year-old boy who complained of abdominal pain, diarrhea (rare occasions), lack of appetite, and headache for 2 months. These patients had not traveled abroad. The cases were treated successfully with co-trimoxazole. Our results suggest that all patient groups with diarrhea and abdominal pain should also be considered in cystoisosporiasis.

Topics: Abdominal Pain; Adolescent; Anti-Infective Agents; Child; Child, Preschool; Diagnosis, Differential; Diarrhea; Feces; Humans; Immunocompetence; Immunocompromised Host; Isospora; Isosporiasis; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Multiple medications have been associated with pancreatitis, however, data in the pediatric population are scarce secondary to the nonspecific presentation and infrequent diagnosis. The aim of this report is to characterize drug-induced pancreatitis in an adolescent patient.. A 16-year-old African-American female presented with a surgical site infection 8 weeks after a motor vehicle accident with multiple traumas. Two weeks prior to the admission, the patient was hospitalized for a urinary tract infection (UTI) and was initiated on sulfamethoxazole/trimethoprim (TMP/SMX) daily for UTI prophylaxis. On day 13, the patient was diagnosed with acute pancreatitis with an amylase level of 187 units/L (normal = 30-110) and a lipase level of 987 units/L (normal = 23-208). TMP/SMX was discontinued, and pancreatic enzyme levels decreased but did not reach normal. The patient was asymptomatic at discharge.. TMP/SMX was identified as the likely etiology of pancreatitis by the medical team. Evaluation with the Naranjo algorithm indicated a "possible" adverse drug reaction.. Acute pancreatitis can have significant morbidity and mortality in the pediatric population but can go undiagnosed due to its lower incidence. Pediatric patients presenting with idiopathic abdominal pain should be evaluated for pancreatitis and drug therapy should be reviewed for potential causative agents.

Topics: Abdominal Pain; Accidents, Traffic; Acute Disease; Adolescent; Anti-Infective Agents, Urinary; Female; Humans; Multiple Trauma; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Whipple's disease is a rare chronic multi-systemic infection, caused by Gram-positive bacillus Tropheryma whipplei. The infection usually involves the small bowel, but other organs may also be involved. The diagnosis is often challenging and can only be made on histopathological examination. This report describes 2 patients presenting with abdominal pain and weight loss who finally were diagnosed to have Whipple's disease. One of the patients was a renal transplant recipient. To the best of authors' knowledge, no case of Whipple's disease has yet been reported in Pakistan. The diagnosis were made on the basis of histopathological evaluation of duodenal biopsies. The cases underscore the need for diligent histopathological evaluation of the upper gastrointestinal biopsies and a high index of suspicion for an accurate diagnosis of the condition. The approach to the diagnosis and management of the condition is discussed.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Biopsy; Ceftriaxone; Female; Humans; Intestine, Small; Male; Pakistan; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Weight Loss; Whipple Disease

Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, in children is an uncommon chronic organ- and life-threatening systemic vasculitis that may share at time of initial presentation a number of clinical features in common with Henoch-Schönlein purpura (HSP), a very common and comparatively benign form of childhood vasculitis. Diagnosis of GPA requires a high index of suspicion, and antineutrophil cytoplasmic antibody tests along with tissue biopsy are helpful tools for diagnosis. We report 2 patients with GPA masqueraded as HSP at time of initial presentation. Both patients presented with nonthrombocytopenic purpura on lower extremities, in addition to abdominal pain, and/or microscopic hematuria and fulfilled both the American College of Rheumatology and the Pediatric Rheumatology European Society classification criteria for HSP. Both patients eventually developed significant renal and pulmonary disease and were diagnosed with GPA. We aim to raise awareness of such atypical presentations of GPA to avoid delayed management.

Topics: Abdominal Pain; Anti-Infective Agents; Antibodies, Antineutrophil Cytoplasmic; Azathioprine; Child; Cyclophosphamide; Diagnosis, Differential; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Glucocorticoids; Granulomatosis with Polyangiitis; Hematuria; Humans; IgA Vasculitis; Immunosuppressive Agents; Male; Plasmapheresis; Proteinuria; Trimethoprim, Sulfamethoxazole Drug Combination

Cyclospora spp. which are coccidian parasites are rare gastroenteritis pathogens. The first cyclosporiasis case in Turkey was reported in 1998 in a patient with AIDS. In this paper we report a case of Cyclospora gastroenteritis, in a patient who was admitted to our hospital and who had had diarrhea, abdominal pain and nausea for ten days. In the anamnesis it was learned that he had travelled to the Black Sea region and had drunk muddy and cloudy water. His physical examination was normal except for increased bowel sounds. There were no leukocytes or erythrocytes in the direct microscopy of the stool and bacteriologic culture did not yield any enteropathogen. Cylospora oocyysts were seen in the parasitologic exmination. The patient was treated with cotrimaxasole (2x1,160/800 mg tablet). There was no pathogen in the repeated stool examination. Our case suggests that parasitologic examination should not be neglected in longlasting diarrhea cases and occasionally Cyclospora may be the causative agent.

Topics: Abdominal Pain; Adult; Anti-Infective Agents; Cyclospora; Cyclosporiasis; Diarrhea; Female; Gastroenteritis; Humans; Nausea; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Pain; Acute Disease; Animals; Blastocystis; Blastocystis Infections; Child, Preschool; Diarrhea; Feces; Follow-Up Studies; Humans; Metronidazole; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Blastocystis hominis is commonly found in the intestinal tract of humans. Although the pathogenicity of this unicellular parasite is controversial, anti-protozoan agents are usually administered to infected individuals. At present, the first choice of chemotherapeutic agent is Metronidazole as described in the literature. In this study, we evaluated the effects of metronidazole and Trimethoprim/Sulfamethoxazole (TMP/SMX) on persons infected with B.hominis. A total of 104 subjects infected with B. hominis were admitted to the laboratory from 2002 to 2003. All individuals were non-immunocompromised and subjects were monitored for 1 year after treatment. All stool samples were microscopically examined after staining with iodine and by culturing in an egg slant medium. Of the 104 infected individuals (52+/-16 years of age, M:F=60:44) with B. hominis infection, 28 were discharging large numbers of parasites before treatment. Of 28 severely infected individuals, 12 were treated with metronidazole/250-750 mg at a regimen of 3 x/day/10 days and 4 of the 12 were eradicated. Nine individuals were treated with TMP/SMX/1 tab at a regimen of 3 x/day/10 days and 2 of the 9 were eradicated. For severe B. hominis infections, it appears that metronidazole and TMP/SMX are effective in some individuals, but not all.

Topics: Abdominal Pain; Animals; Anti-Infective Agents; Antiprotozoal Agents; Blastocystis hominis; Blastocystis Infections; Dose-Response Relationship, Drug; Feces; Female; Humans; Male; Metronidazole; Middle Aged; Surveys and Questionnaires; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Pain; Anemia, Hemolytic, Autoimmune; Child; Female; Humans; Prednisolone; Respiratory Tract Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Pain; Adult; Amebicides; Combined Modality Therapy; Diarrhea; Drainage; Emergency Treatment; Fever; Humans; Liver Abscess, Amebic; Male; Metronidazole; Paromomycin; Point-of-Care Systems; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional

Blastocystis hominis (B. hominis) is a common intestinal parasite that has long been considered nonpathogenic. Recently there have been many reports supporting a role for the organism as a potential pathogen. We performed a study to examine the pathogenicity of B. hominis and the effect of trimethoprim-sulfamethaxazole (TMP-SMX) on this organism.. Stool samples of patients, who came to the Department of Parasitology, Faculty of Medicine, Celal Bayar University, were examined by direct wet-mount, trichrome staining, formalin-ethyl acetate concentration, and Kinyoun acid fast techniques for intestinal parasites, and bacteriological stool cultures were performed. Fifty-three symptomatic patients (38 children and 15 adults) with two consequent stool samples positive for abundant B. hominis (five or more organisms per x400 field) and negative for other parasitic and bacterial pathogens were treated with TMP-SMX for 7 days, children 6 mg/kg TMP, 30 mg/kg SMX, and adults 320 mg TMP, 1600 mg SMX, daily. On the seventh day, at the end of treatment, stool samples of all patients were examined by same methods, and clinical symptoms were again evaluated.. B. hominis was eradicated in 36 of 38 (94.7%) children, and 14 of 15 (93.3%) adults. Clinical symptoms disappeared in 39 (73.6%), decreased in 10 (18.9%), and no change was observed in one (1.9%) patient, whereas symptoms persisted in all three (5.7%) patients in whom B. hominis could not be eradicated. Mean number of stools per day was significantly decreased from 4.3 to 1.2 in the 33 children (p < 0.001), and decreased from 3.5 to 1.0 in the four adults (p = 0.06) with diarrhea.. These results suggested that B. hominis may be pathogenic, especially when it is present in large numbers, and TMP-SMX is highly effective against this organism. Although there are some anecdotal reports, to our knowledge this is the first study examining the effect of TMP-SMX on B. hominis in humans.

Topics: Abdominal Pain; Adolescent; Adult; Aged; Animals; Anti-Infective Agents; Blastocystis hominis; Blastocystis Infections; Child; Child, Preschool; Diarrhea; Feces; Follow-Up Studies; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

We reviewed hospital records of women on the obstetrics and gynecologic services with a diagnosis of antibiotic-associated diarrhea, pseudomembranous colitis, or Clostridium difficile infection to better characterize the incidence and course of women with C difficile infection. Cases were included if there was identification of C difficile by culture or toxin or endoscopic verification of pseudomembranous colitis. Between January 1985 and June 1995, there were 74,120 admissions to the obstetrics and gynecology services at two tertiary level hospitals. Eighteen women were found to have documented C difficile infection (0.02%)--3 from the obstetric services, 10 from the benign gynecologic services, and 5 from the gynecologic/oncology services. Diarrhea developed from 2 days to 30 days after antibiotics had been given (mean, 10 days). Nine patients had fever, six had nausea and vomiting, and five had abdominal pain. Antimicrobial agents given before infection included cephalexin, cefoxitin, imipenem, ciprofloxacin, trimethoprim/sulfamethoxazole, ampicillin, gentamicin, and clindamycin. All patients were treated successfully with inpatient antimicrobial agents-15 with metronidazole and 3 with vancomycin. There was one possible recurrence.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Bacterial Toxins; Cefoxitin; Cephalexin; Cephalosporins; Cephamycins; Ciprofloxacin; Clindamycin; Clostridioides difficile; Colonoscopy; Diarrhea; Enterocolitis, Pseudomembranous; Female; Fever; Gentamicins; Humans; Imipenem; Incidence; Middle Aged; Nausea; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting

Topics: Abdominal Pain; Acquired Immunodeficiency Syndrome; Acute Disease; Adult; Cholelithiasis; Cryptosporidiosis; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination