trimethoprim--sulfamethoxazole-drug-combination and Acute-Disease

Topics: Acute Disease; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Deprescriptions; Female; Glucocorticoids; Humans; Male; Methylprednisolone; Nephritis, Interstitial; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination

The case report describes a woman who has an acute psychosis episode during the second course of trimethoprim/sulfamethoxazole therapy, after having an allogeneic hematopoietic stem cell transplant that favored a dose-related effect of this adverse effect.

Topics: Acute Disease; Adult; Anti-Infective Agents; Dose-Response Relationship, Drug; Female; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid, Acute; Psychoses, Substance-Induced; Risk Factors; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Acute bronchitis affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. One third of people may have longer-term symptoms or recurrence.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, antibiotics (macrolides, tetracyclines, cephalosporins, penicillins, or trimethoprim-sulfamethoxazole [co-trimoxazole]), antihistamines, antitussives, beta(2) agonists (inhaled or oral), and expectorants/mucolytics.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Antitussive Agents; Bronchitis; Humans; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination

Acute uncomplicated lower urinary tract infection (UTI) is one of the most common problems for which young women seek medical attention.. To compare the efficacy, resistance development and safety of different antimicrobial treatments for acute uncomplicated lower UTI.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's Specialised Register, MEDLINE, EMBASE and bibliographies of included studies.. Randomised controlled trials (RCTs) comparing different classes of antimicrobials for acute uncomplicated UTI in women were included. The outcomes of interest were symptomatic and bacteriological cure at short and long-term follow-up, resistance development, number of days to symptom resolution, days of work loss, adverse events and complications.. Two authors independently extracted the data and assessed study quality. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) with 95% confidence intervals (CI).. Trimethoprim-sulfamethoxazole (TMP-SMX) was as effective as fluoroquinolones in achieving short-term (RR 1.00, 95% CI 0.97 to 1.03) and long-term (RR 0.99, 95% CI 0.94 to 1.05) symptomatic cure. Beta-lactam drugs were as effective as TMP-SMX for short-term (RR 0.95' 95% CI 0.81 to 1.12) and long-term (RR 1.06' 95% CI 0.93 to 1.21) symptomatic cure. Short-term cure for nitrofurantoin was similar to that of TMP-SMX (RR 0.99' 95% CI 0.95 to 1.04) as was long-term symptomatic cure (RR 1.01' 95% CI 0.94 to 1.09).Fluoroquinolones were more effective than beta-lactams (RR 1.22, 95% CI 1.13 to 1.31) for short-term bacteriological cure. Rashes were more frequent in patients treated with TMP-SMX than with nitrofurantoin or fluoroquinolones and in patients treated with beta-lactam drugs compared to fluoroquinolones. Minimal data were available on the emergence of resistant strains during or after antimicrobial treatment.. No differences were observed between the classes of antimicrobials included in this review for the symptomatic cure of acute uncomplicated UTI. Fluoroquinolones proved more effective than beta-lactams for the short-term bacteriological outcome, probably with little clinical significance. Individualised treatment should take into consideration the predictable susceptibility of urinary pathogens in local areas, possible adverse events and resistance development, and patient preference.

Topics: Acute Disease; Anti-Infective Agents; Anti-Infective Agents, Urinary; beta-Lactams; Female; Fluoroquinolones; Humans; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To compare the effectiveness and toxicity of semisynthetic penicillins (SSPs) (amoxicillin, ampicillin, pivampicillin) and trimethoprim-based regimens (trimethoprim, trimethoprim-sulfamethoxazole, trimethoprim-sulfadiazine) in treating acute bacterial exacerbations of chronic bronchitis (ABECB).. We searched MEDLINE, EMBASE, Current Contents, and the Cochrane Central Register of Controlled Trials to identify and extract data from relevant randomized controlled trials (RCTs).. Only RCTs comparing penicillins with trimethoprim-based regimens for the treatment of patients with ABECB that reported data on effectiveness, toxicity, or mortality were considered eligible for this meta-analysis.. Out of 134 RCTs identified in the search, 5 RCTs involving 287 patients were included in the analysis. There were no differences between patients with ABECB treated with SSPs and those treated with trimethoprim, alone or in combination with a sulfonamide, in treatment success (intention-to-treat patients: n = 262, odds ratio [OR] 1.68, 95% confidence interval [CI] 0.91-3.09; clinically evaluable patients: n = 246, OR 1.59, 95% CI 0.79-3.20) or number of drug-related adverse events in general (n = 186 patients, OR 0.37, 95% CI 0.11-1.24), frequency of diarrhea or skin rashes, or number of withdrawals due to adverse events (n = 179 patients, OR 0.27, 95% CI 0.07-1.03).. Based on limited evidence leading to wide CIs of the estimated treatment effects, SSPs and trimethoprim-based regimens seem to be equivalent in terms of effectiveness and toxicity for ABECB.

Topics: Acute Disease; Amoxicillin; Anti-Infective Agents; Bronchitis, Chronic; Drug Therapy, Combination; Humans; Pivampicillin; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Cystitis is a bacterial infection of the lower urinary tract which causes pain when passing urine, and causes urgency, haematuria, and suprapubic pain not associated with passing urine. Recurrent cystitis is usually defined as three episodes of urinary tract infection in the previous 12 months, or two episodes in the previous 6 months.. We conducted a systematic review and aimed to answer the following clinical question: Which interventions prevent further recurrence of cystitis in women experiencing at least two infections per year? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: continuous antibiotic prophylaxis (trimethoprim, co-trimoxazole, nitrofurantoin, cefaclor, or a quinolone or cephalexin); continuous prophylaxis with methenamine hippurate; cranberry juice and cranberry products; oestrogen (topical) in postmenopausal women; passing urine after intercourse; postcoital antibiotic prophylaxis; single-dose self-administered antibiotic.

Topics: Acute Disease; Bacterial Infections; Cystitis; Female; Humans; Incidence; Nitrofurantoin; Prospective Studies; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, otitis media, and sinusitis; it results in significant morbidity and mortality in patients with pneumonia and meningitis. The pneumococcus is a common colonizing bacterium in the respiratory tract; it is especially common in the respiratory tracts of children, where it is frequently exposed to antimicrobial agents. This exposure can lead to resistance. Penicillin nonsusceptibility is found in nearly 40% of strains causing disease in adults, although often these cases are treatable with appropriate dosing regimens of many oral and parenteral beta-lactam agents. In the United States resistance to macrolides is widespread--averaging approximately 28%--but geographically variable, ranging from 23% in the northwest to 30% in the northeast. Resistance to tetracyclines and trimethoprim-sulfamethoxazole are reported in approximately 20% and 35% of isolates, respectively, and resistance to multiple classes of agents is increasingly common. Amoxicillin, amoxicillin-clavulanate, respiratory fluoroquinolones, and clindamycin are currently the most effective agents for treatment of respiratory tract infections caused by S pneumoniae, with >90% of isolates in the United States being susceptible. Vancomycin is the only agent against which resistance has not emerged. Patient groups that are at increased risk for developing resistant pneumococcal infections have been identified and include patients with malignancies, human immunodeficiency virus infection, and sickle-cell disease. Judicious use of antimicrobials is the key to preventing the emergence of further resistance, particularly as few new classes of agents are likely to become available for clinical use in the short term.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; beta-Lactam Resistance; Community-Acquired Infections; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Macrolides; Microbial Sensitivity Tests; Pneumococcal Infections; Pneumonia, Pneumococcal; Prevalence; Risk Factors; Sinusitis; Streptococcus pneumoniae; Tetracyclines; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Empirical antimicrobial treatment for acute cystitis in women requires continuing reassessment as the antimicrobial susceptibility of community isolates of Escherichia coli evolves. Current recommendations for 3 days trimethoprim or trimethoprim/sulphamethoxazole are compromised by increasing resistance of community E. coli to these agents. Fluoroquinolones are an alternate 3-day therapy, but increasing resistance is being reported from some countries, and widespread community use may promote resistance, limiting effectiveness of these agents for more serious infections. Alternate regimens supported by recent clinical trials suggest pivmecillinam given twice daily for 7 days is as effective as 3 days of quinolone therapy, while microbiological cure is 80% with 3 days therapy twice daily, and 90% with 3 days therapy thrice daily. Nitrofurantoin given for 7 days has a cure rate of 80-85%. Fosfomycin trometamol as a single dose has cure rates of 75-85%. All these agents are effective, but a compromise in efficacy or duration of therapy compared with current 3-day regimens may have to be considered.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Clinical Trials as Topic; Cystitis; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Anti-Infective Agents, Urinary; Bacteriuria; Cystitis; Diagnosis, Differential; Drug Administration Schedule; Female; Humans; Practice Guidelines as Topic; Pyelonephritis; Pyuria; Risk Factors; Secondary Prevention; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In 1995, >5 million episodes of acute otitis media (AOM) accounted for $3 billion in health care expenditures.. To synthesize the literature on the natural history of AOM, the effectiveness of antibiotic treatment in uncomplicated AOM, and the relative effectiveness of specific antibiotic regimens.. Seven electronic databases for articles published between 1966 and March 1999 and reference lists in proceedings, published articles, reports, and guidelines.. Two physicians independently assessed each article. Studies addressing AOM in children 4 weeks to 18 years old were included; those addressing children with immunodeficiencies or craniofacial abnormalities were excluded. Randomized, controlled trials (RCTs) were used to assess antibiotic effectiveness, and RCTs and cohort studies were used to assess the natural history of AOM. Among the 3491 citations identified, 80 (2.3%) met our inclusion criteria.. Two physicians independently abstracted data and assessed the quality of studies using a validated scale for RCTs and 8 quality components for cohort studies.. Random-effects estimates of pooled absolute rate differences of outcomes were derived, and heterogeneity of both the rates and rate differences was assessed. Children with AOM not treated with antibiotics experienced a 1- to 7-day clinical failure rate of 19% (95% confidence interval: 0.10-0.28) and few suppurative complications. When patients were treated with amoxicillin, the 2- to 7-day clinical failure rate was reduced to 7%, a 12% (95% confidence interval: 0.04-0.20) reduction. Adverse effects, primarily gastrointestinal, were more common among children on cefixime than among those on ampicillin or amoxicillin. They were also more common among children on amoxicillin-clavulanate than among those on azithromycin.. The majority of uncomplicated cases of AOM resolve spontaneously without apparent suppurative complications. Ampicillin or amoxicillin confers a limited therapeutic benefit. There is no evidence to support any particular antibiotic regimens as more effective at relieving symptoms. Certain antibiotics are more likely than others to cause diarrhea and other adverse events.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cohort Studies; Diarrhea; Dose-Response Relationship, Drug; Drug Administration Schedule; Evidence-Based Medicine; Humans; Infant; Otitis Media with Effusion; Penicillins; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

ANTIBIOTIC EFFICACY: According to early studies, antibiotics have moderate efficacy in acute exacerbation of chronic bronchitis. The lack of efficacy is particularly clear for patent exacerbation with marked alteration of respiratory function. Recent studies have shown that newer compounds exhibit an efficacy similar (no proven superiority) to comparison compounds (75 to 95% favorable outcome with treatment). The recommendations of the IVth Consensus Conference on Anti-infectious Therapy thus propose first line antibiotic therapy for patients with a forced expiratory volume in 1 second (FEV1) between 80 and 35% and broader spectrum and new antibiotics in case of failure of the first line treatment for patients with severe obstruction or frequently recurrent exacerbation.. Using exacerbation-free interval, reduction in the number of exacerbations, duration of treatment and/or hospital stay as evaluation criteria, interesting results are obtained with amoxicillin/clavulanic acid, azithromycin, and ciprofloxacin. Independent factors predictive of therapeutic failure are, according to one study, FEV1 less than 35%, ambulatory administration of oxygen, more than 4 acute exacerbations within 24 months, history of pneumonia or sinusitis, and requirement for long-term corticosteroid therapy. Factors predictive of recurrence are, according to another study, dependence on oxygen therapy, prolonged corticosteroid therapy, smoking, and/or heart disease. Cost effectiveness is particularly interesting with ciprofloxacin, especially in more severe patients.. It is important to target antibiotic therapy for acute exacerbation of chronic bronchitis specifically for patients who will truly benefit, adapting the prescribed compound to the bacterial target.

Topics: Acute Disease; Adrenal Cortex Hormones; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bronchitis, Chronic; Ciprofloxacin; Clavulanic Acid; Clinical Trials as Topic; Cost-Benefit Analysis; Double-Blind Method; Drug Therapy, Combination; Erythromycin; Humans; Maximal Expiratory Flow-Volume Curves; Multicenter Studies as Topic; Penicillins; Placebos; Practice Guidelines as Topic; Prognosis; Recurrence; Respiratory Function Tests; Tetracycline; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

The major problems encountered in the antibiotic therapy of acute otitis media (AOM) are the tremendous increase in the resistance to antibiotics of its main pathogens and the lack of tight criteria (taking into consideration, as a major determinant, the eradication of the pathogens from the middle ear fluid) in the selection of the appropriate antibiotic drugs for the treatment of this disease. Future drugs for the treatment of AOM will have to be approved only after their in vivo microbiological efficacy for each major pathogen is documented. This documentation will be provided by more antibiotic studies with bacteriological outcome using the double-tympanocentesis method and stratifying the AOM patients by age and initial clinical severity. Judicious use of antibiotics for the treatment of AOM will have a major impact on society, leading to a less frequent but more skilled administration of the most effective drugs.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Drug Resistance, Microbial; Humans; Macrolides; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Massive hepatic necrosis following exposure to phenytoin and trimethoprim-sulfamethoxazole is a rare occurrence and to the best of our knowledge has not been reported previously. Acute hepatic failure following administration of trimethoprim-sulfamethoxazole has rarely been seen, and only 4 cases have been well documented pathologically. We report a case of acute liver failure in a 60-year-old woman following ingestion of phenytoin and trimethoprim-sulfamethoxazole concomitantly over a 9-day period. Autopsy findings revealed acute fulminant hepatic failure. This case demonstrates the effects of chemical-chemical interactions in the potentiation of hepatotoxicity of single agents and specifically illustrates the need for discontinuing trimethoprim-sulfamethoxazole in the presence of early liver injury.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Child, Preschool; Drug Interactions; Fatal Outcome; Female; Hepatic Encephalopathy; Humans; Liver; Middle Aged; Necrosis; Phenytoin; Trimethoprim, Sulfamethoxazole Drug Combination

Most patients with acute bronchitis who seek medical care are treated with antibiotics, although the effectiveness of this intervention is uncertain. We performed a meta-analysis of randomized, controlled trials to estimate the effectiveness of antibiotics in the treatment of acute bronchitis.. English-language studies published January 1966 to April 1998 were retrieved using MEDLINE, bibliographies, and consultation with experts. Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included.. We identified eight randomized controlled trials that satisfied all inclusion criteria. These studies used one of three antibiotics (erythromycin, doxycycline, trimethoprim/sulfamethoxazole). The use of antibiotics decreased the duration of cough and sputum production by approximately one-half day (summary effect size 0.21; 95% CI, 0.05 to 0.36). For specific symptoms, there were nonsignificant trends favoring the use of antibiotics: a decrease of 0.4 days of purulent sputum (95% CI, -0.1 to 0.8), a decrease of 0.5 days of cough (95% CI, -0.1 to 1.1), and a decrease of 0.3 days lost from work (95% CI, -0.6 to 1.1).. This meta-analysis suggests a small benefit from the use of the antibiotics erythromycin, doxycycline, or trimethoprim/sulfamethoxazole in the treatment of acute bronchitis in otherwise healthy patients. As this small benefit must be weighed against the risk of side effects and the societal cost of increasing antibiotic resistance, we believe that the use of antibiotics is not justified in these patients.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Doxycycline; Erythromycin; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Aeromonas species, once thought pathogenic only in immunocompromised hosts, have more recently been found to be associated with many different infections in previously healthy individuals. The most common site of these infections is the gastrointestinal tract. We describe a 67-yr-old woman who presented with abdominal pain and bloody diarrhea and was diagnosed with left-sided, segmental colitis due to Aeromonas sobria, which was proven by stool culture. Extensive work-up for ischemic colitis was unremarkable, and after treatment with antibiotics, the patient's symptoms resolved, and follow-up colonoscopy failed to reveal any evidence of residual colitis or inflammatory bowel disease. Our report supports the view that Aeromonas species need to be considered in the differential diagnosis of colitis, and we believe it to be the first report of left-sided, segmental colitis secondary to Aeromonas sobria infection.

Topics: Acute Disease; Aeromonas; Aged; Anti-Bacterial Agents; Colitis; Diarrhea; Endoscopy, Digestive System; Feces; Female; Gram-Negative Bacterial Infections; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Pancreatic disease in patients with AIDS often is so mild that the diagnosis may be missed. The pancreas can be affected by systemic illness caused by opportunistic infections, Kaposi's sarcoma, or lymphoma. More commonly, drugs used to treat patients infected with human immunodeficiency virus can cause pancreatitis and result in significant morbidity and, rarely, mortality. We report one such case in a 47-year-old patient with AIDS in whom pancreatitis developed while taking 2',3'-dideoxyinosine (ddI). His condition improved on ddI withdrawal, but he suffered a fatal relapse while receiving 2',3'-dideoxycytidine and trimethoprim-sulfamethoxazole. This case gives me the opportunity to review the literature regarding the incidence, causes, and diagnosis of human immunodeficiency virus-associated pancreatitis.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Anti-Infective Agents; Antiviral Agents; Fatal Outcome; Humans; Male; Middle Aged; Pancreatitis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

The pancreas is frequently involved during HIV infection, especially by disseminated infections or neoplasms. These lesions are generally asymptomatic and are discovered at autopsy. However, hypoglycaemia secondary to massive pancreatic infiltration by a tumour or tuberculous necrosis may occur. The most important cause of pancreatic dysfunction in HIV-infected patients is a drug toxic effect (intravenous pentamidine, didanosine, zalcitabine). Hypoglycaemia, which may or may not be followed by diabetes, can develop during intravenous pentamidine therapy. In cases with increased serum amylase and/or lipase levels, potentially toxic drugs must be promptly discontinued to avoid major pancreatic involvement.

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Didanosine; HIV Infections; Humans; Pancreas; Pancreatic Diseases; Pancreatitis; Pentamidine; Trimethoprim, Sulfamethoxazole Drug Combination; Zalcitabine

Cholera is an acute intestinal infection caused by Vibrio cholerae 01. When an infected person presents severe dehydration and is not adequately treated, he or she will develop hypovolemic shock and eventually could died. There is scarce information concerning this disease in the Pediatric group. Herein we report on eight cases of Pediatric cholera, in children 17 month to four years of age. Seven patients out of eight were admitted presenting dehydration. Four presenting mild or moderate dehydration and three presenting hypovolemic shock. These three patients were rehydrated by intravenous route and thereafter the hydration was maintained by oral therapy. The outcome was uneventful in six patients. One patient developed abdominal distention probably due to hypopotassemia, and another patient presented hyponatremia and seizures. All the patients recovered within five days after admission.

Topics: Acute Disease; Child, Preschool; Cholera; Combined Modality Therapy; Feces; Female; Fluid Therapy; Humans; Infant; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

Acute bronchitis is a common clinical problem that causes considerable morbidity and presents both diagnostic and treatment dilemmas for the physician. An evaluation of all published randomized controlled trials of antibiotics in the treatment of acute bronchitis was conducted to (1) quantitatively assess methodologic rigor, (2) determine if effectiveness of antimicrobial therapy is known, and (3) analyze strengths and weaknesses of randomized controlled trials in family practice settings.. A scoring system for the evaluation of randomized controlled trials was adapted for this study. Four raters, who were blinded to which journals published the studies and the type of antibiotic used in each study, assessed the six-randomized clinical trials for treatment of bronchitis identified through a literature search. The trials were rated according to criteria that measured internal validity.. Scores for internal validity ranged from 65.5 to 102.5 points with a maximum possible score of 120 points (54.6% to 85.4%). The two trials with the highest scores assessed doxycycline and showed no benefit from use of this antibiotic. Single trials that studied erythromycin and trimethoprim-sulfamethoxazole showed improvement in outcome from use of these drugs; however, of the six trials, these two studies ranked fourth and fifth for internal validity. Low scores resulted from small sample size, possible contamination with other treatment measures, and poor assessment of subjects' compliance with antibiotic regimen.. An evaluation of the current literature does not support antibiotic treatment for acute bronchitis. Further studies of this common illness are indicated. It is hoped that this critical review of randomized control trials will prove useful in the planning of future studies, in placing greater emphasis on methodologic rigor, and in giving greater consideration to the practical constraints of research in the family practice setting.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Erythromycin; Family Practice; Humans; Placebos; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary tract infections continue to be a major health problem for women. Understanding of the pathogenesis of urinary tract infections has improved; Staphylococcus saprophyticus has been recognized as a common causative agent, and low-colony-count infections are misdiagnosed less often. Traditional therapy with 10 days of amoxicillin (Amoxil, Wymox) or ampicillin (Omnipen, Totacillin) is no longer considered optimal. For women who fulfill certain clinical criteria, short-course therapy is recommended--preferably 3 days of trimethoprim-sulfamethoxazole, or trimethoprim alone (Proloprim, Trimpex) if the woman is allergic to sulfonamides. Longer therapy is indicated for women with complicated, prolonged, or recurrent infections. To appropriately treat patients and avoid overtreatment that would increase both costs and the incidence of side effects, physicians need to stay abreast of information about pathogens, mechanisms of disease, new drugs, and common resistance patterns.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cost-Benefit Analysis; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Nitrofurantoin; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacterial prostatitis can be distinguished from nonbacterial prostatitis on the basis of the symptoms, the findings on physical examination and the results of microbiologic testing. Evaluation of fractionated urine specimens, including expressed prostatic secretions, is helpful in making the diagnosis. Bacterial prostatitis may be acute or chronic. Acute prostatitis can be a serious illness requiring inpatient treatment with parenteral antibiotics. Chronic prostatitis is difficult to cure, and prolonged antibiotic therapy is required for eradication of symptoms. The most useful agents for the treatment of prostatitis include trimethoprim-sulfamethoxazole and the fluoroquinolones. Evidence indicates that fluoroquinolones may result in superior symptom control and microbiologic cure.

Topics: 4-Quinolones; Acute Disease; Anti-Infective Agents; Bacterial Infections; Chronic Disease; Humans; Male; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Topics: Acute Disease; Anti-Bacterial Agents; Ciprofloxacin; Colistin; Drug Therapy, Combination; Humans; Infection Control; Infections; Leukemia; Multicenter Studies as Topic; Neutropenia; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Administration, Oral; Adolescent; Child; Child, Preschool; Drug Combinations; Hematologic Diseases; Humans; Infant; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

A 19 year-old man developed an acute syndrome of the anterior horn of cervical spinal cord during a primo-infection with toxoplasma. The neurological syndrome was completely regressive after treatment with 1 600 mg/day of trimethoprim-sulfamethoxazole for three months.

Topics: Acute Disease; Adult; Humans; Male; Muscular Atrophy, Spinal; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical pattern of 400 cases of brucellosis in Kuwait is presented. The disease was acute in 77 per cent, sub-acute in 12.5 per cent and chronic in 10.5 per cent of cases. Raw milk was the major source of infection. The major features on presentation, irrespective of the course of the disease, were fever, sweating, headache, rigors, arthralgia, myalgia, and low back pain. Hepatosplenomegaly was present in 41 per cent of cases and in 32 per cent neither liver nor spleen were palpable. The haematologic findings were not specific and hepatic dysfunction (shown by liver enzyme abnormalities) was common. Skeletal (26 per cent) and genital (8.5 per cent) changes and neurobrucellosis (7 per cent) were the major complications. The ELISA was the most sensitive and reliable diagnostic test especially in relation to chronic brucellosis and neurobrucellosis. ELISA allowed the determination of brucella-specific immunoglobulins (Ig)G, IgM and IgA in the CSF, and provided profiles of Ig, in sera, which were different in patients with chronic (elevated IgG and IgA) from those with acute (elevated IgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline, doxycycline or rifampicin gave a cure rate of over 91 per cent in acute and subacute brucellosis. Co-trimoxazole was associated with a relapse rate of 50 per cent. Two drug combinations of streptomycin and tetracycline, streptomycin and rifampicin or streptomycin and doxycycline were effective, but one of five patients with chronic brucellosis relapsed. A combination of streptomycin, tetracycline and rifampicin with or without steroids was used successfully in neurobrucellosis, septicaemic shock and subacute bacterial endocarditis.

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Brucellosis; Child; Chronic Disease; Drug Combinations; Drug Therapy, Combination; Female; Humans; Kuwait; Male; Middle Aged; Prospective Studies; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic treatment of acute otitis media (AOM) accounts for a significant number of all antibiotic prescriptions each year. In the primary care setting, initial antibiotic selection is rarely based on direct evidence, such as cultures of middle ear fluid. Initial antibiotic therapy by the primary care practitioner involves the evaluation and application of information related to prevalence of infecting organisms; in vitro antibiotic spectrum and penetration into middle ear fluid; initial cure rate, relapse and recurrence rates; and antibiotic cost, safety, and convenience. The influence of these factors on the initial antibiotic choice for AOM is reviewed. Several therapeutic dilemmas confronting the prescriber are discussed and a rational approach to initial antibiotic therapy is presented.

Topics: Acute Disease; Anti-Bacterial Agents; Drug Combinations; Humans; Otitis Media; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Although controversies remain regarding the definition, diagnosis, and management of urinary tract infections, such infections can pose a major risk to a child's well-being. Bacteriuria or recurrent urinary tract infections often pose difficult management problems. Symptomatic and asymptomatic bacteriuria during infancy are generally characterized by a benign outcome. In some children repeated episodes and, possibly, renal scarring result. The prognosis in young boys may be guarded if neonatal bacteriuria, with or without symptoms, occurs in the presence of anatomic defects. Although a variety of pathogens have been identified as causing urinary tract infections, Enterobacteriaceae are usually the cause of initial uncomplicated lower tract infections. Accepted therapy for such infections is reviewed, as are the combination therapies used for hospitalized patients with upper tract infections. An investigation of piperacillin, a new, extended-spectrum acylaminopenicillin, raises the hope that it may provide effective monotherapy for upper tract infections. The criteria for selecting patients who require radiologic evaluation in the management of urinary tract infections are reviewed.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Drug Combinations; Female; Humans; Long-Term Care; Male; Piperacillin; Prognosis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Environment, Controlled; Gentamicins; Humans; Leukemia; Neoplasms; Nystatin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

and purpose: Different in vitro studies have reported the antimicrobial effects of green tea catechins and also their synergistic effects with trimethoprim-sulfamethoxazole against E. coli. The aim of the present study was to evaluate the efficacy of green tea as an adjunctive therapy to standard antimicrobial treatment in women with acute uncomplicated cystitis.. In this blinded randomized trial, 70 patients were assigned to receive four 500 mg capsules of green tea or starch as placebo daily for three days along with trimethoprim-sulfamethoxazole. The presence of acute uncomplicated cystitis symptoms was recorded and urinalysis was performed.. Women in the green tea group showed a statistically significant decrease in the prevalence of cystitis symptoms and a statistically significant improvement in the urinalysis results except for hematuria after 3 days of treatment.. Green tea was an effective adjunct to trimethoprim-sulfamethoxazole to treat acute uncomplicated cystitis in women.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Cystitis; Escherichia coli; Female; Humans; Middle Aged; Prevalence; Tea; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

There is a paucity of data on the efficacy of nitrofurantoin for the treatment of acute uncomplicated cystitis in regimens shorter than 7 days. Evidence-based use of this drug is increasingly important as trimethoprim-sulfamethoxazole resistance among uropathogens increases.. To assess the efficacy of nitrofurantoin vs trimethoprim-sulfamethoxazole, 338 women aged 18 to 45 years with acute uncomplicated cystitis were randomized to open-label treatment with either trimethoprim-sulfamethoxazole, 1 double-strength tablet twice daily for 3 days, or nitrofurantoin, 100 mg twice daily for 5 days. Clinical cure 30 days after therapy was the main outcome measure. Secondary outcomes included clinical and microbiological cure rates 5 to 9 days after therapy and, for trimethoprim-sulfamethoxazole-treated women, clinical cure stratified by the trimethoprim-sulfamethoxazole susceptibility of the uropathogen.. Clinical cure was achieved in 79% of the trimethoprim-sulfamethoxazole group and in 84% of the nitrofurantoin group, for a difference of -5% (95% confidence interval, -13% to 4%). Clinical and microbiological cure rates at the first follow-up visit were also equivalent between the 2 groups. In the trimethoprim-sulfamethoxazole arm, 7 of 17 women (41%) with a trimethoprim-sulfamethoxazole-nonsusceptible isolate had a clinical cure compared with 84% of women with a trimethoprim-sulfamethoxazole-susceptible isolate (P < .001).. A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The purpose of this study was to assess the pretherapy microbiology and fluoroquinolone susceptibility of pathogens from 650 patients with complicated urinary tract infection (cUTI) or acute pyelonephritis (AP) as part of a multicenter, randomized, controlled clinical trial.. In this post hoc analysis of a multicenter, randomized, double-blind study, adults with a clinical diagnosis of cUTI or AP were recruited from 130 community-based and institution-based study centers in the United States from November 2004 through April 2006. Urine and blood culture specimens were identified and tested for susceptibility according to Clinical and Laboratory Standards Institute methods. Presence of a pathogen in the urine culture was confirmed by a colony count of =105 colony-forming units per milliliter. Susceptibility to nonstudy drugs (trimethoprim/sulfamethoxazole [TMP/SMX] and ampicillin) and to study drugs (levofloxacin and ciprofloxacin) was categorized as susceptible, intermediate, or resistant.. Six hundred fifty patients (417 women, 233 men; age range, 18-94 years) with a diagnosis of cUTI or AP were recruited. A total of 68.2% patients (224 men, 219 women) were diagnosed with cUTI, and 31.8% (198 women, 9 men), with AP. Most (646/650 [99.4%]) infections were community acquired. The most common pathogen was Escherichia coli (65.6%), although 12.2% of patients had gram-positive pathogens. Testing for susceptibility to ampicillin and TMP/SMX found that 50.1% and 22.1% of gramnegative pathogens were fully resistant to ampicillin and TMP/SMX, respectively. However, 91.9% of isolates were susceptible to levofloxacin and ciprofloxacin, with 6.5% of isolates resistant or intermediately resistant to levofloxacin, and 9.7% of isolates resistant or intermediately resistant to ciprofloxacin at study entry (P < 0.001 [Stuart-Maxwell test]). All isolates resistant to levofloxacin were also resistant to ciprofloxacin, whereas 6 isolates that were fully susceptible to levofloxacin were fully resistant to ciprofloxacin.. In this study, the level of fluoroquinolone susceptibility of urinary pathogens was high (90.6% in cUTI; 98.1% in AP).

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Double-Blind Method; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Pyelonephritis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Although acute cystitis is a common infection in women, the impact of this infection and its treatment on women's quality of life (QOL) has not been previously described.. To evaluate QOL in women treated for acute cystitis, and describe the relationship between QOL, clinical outcome and adverse events of each of the interventions used in the study.. Randomized, open-label, multicenter, treatment study.. Two family medicine outpatient clinics in Iowa.. One-hundred-fifty-seven women with clinical signs and symptoms of acute uncomplicated cystitis.. Fifty-two patients received trimethoprim/sulfamethoxazole 1 double-strength tablet twice daily for 3 days, 54 patients received ciprofloxacin 250 mg twice daily for 3 days and 51 patients received nitrofurantoin 100 mg twice daily for 7 days.. QOL was assessed at the time of enrollment and at 3, 7, 14 and 28 days after the initial visit. QOL was measured using a modified Quality of Well-Being scale, a validated, multi-attribute health scale. Clinical outcome was assessed by telephone interview on days 3, 7, 14 and 28 using a standardized questionnaire to assess resolution of symptoms, compliance with the prescribed regimen, and occurrence of adverse events.. Patients experiencing a clinical cure had significantly better QOL at days 3 (p = 0.03), 7 (p < 0.001), and 14 (p = 0.02) compared to patients who failed treatment. While there was no difference in QOL by treatment assignment, patients experiencing an adverse event had lower QOL throughout the study period. Patients treated with ciprofloxacin appeared to experience adverse events at a higher rate (62%) compared to those treated with TMP/SMX (45%) and nitrofurantoin (49%), however the difference was not statistically significant (p = 0.2).. Patients experiencing cystitis have an increase in their QOL with treatment. Those experiencing clinical cure have greater improvement in QOL compared to patients fail therapy. While QOL is improved by treatment, those reporting adverse events have lower overall QOL compared to those who do not experience adverse events. This study is important in that it suggests that both cystitis and antibiotic treatment can affect QOL in a measurable way.

Topics: Acute Disease; Adult; Anti-Infective Agents, Urinary; Ciprofloxacin; Cystitis; Female; Humans; Middle Aged; Nitrofurantoin; Outcome and Process Assessment, Health Care; Patient Compliance; Quality of Life; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

One hundred sixty-three women with uncomplicated acute lower urinary tract infections were included in a multicenter randomized study comparing cefpodoxime-proxetil (one 100-mg tablet twice daily) with trimethoprim-sulfamethoxazole (one double-strength tablet [160/800 mg] twice daily) for 3 days. A total of 30 women in both arms were excluded from the study for various reasons. At 4 to 7 days after the discontinuation of therapy, 62 of 63 (98.4%) cefpodoxime-proxetil recipients and 70 of 70 (100%) trimethoprim-sulfamethoxazole patients were clinically cured and demonstrated bacteriological eradication, respectively. At 28 days after treatment, 48 of 55 (87.3%) and 43 of 50 (86%) cefpodoxime-proxetil recipients as well as 51 of 60 (85%) and 42 of 50 (84%) trimethoprim-sulfamethoxazole recipients were clinically cured and demonstrated bacteriological eradication, respectively. Independently of the prescribed regimen, a significant difference (P < 0.001) in failure rates was observed only for patients with a previous history of three or more episodes of acute cystitis per year. With the exception of one patient in the trimethoprim-sulfamethoxazole arm who discontinued therapy because of gastrointestinal pain, both antimicrobials were well tolerated. In conclusion, cefpodoxime-proxetil treatment for 3 days was as safe and effective as trimethoprim-sulfamethoxazole for 3 days for the treatment of uncomplicated acute cystitis in women.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefpodoxime Proxetil; Ceftizoxime; Cystitis; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Middle Aged; Prospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic-resistant pneumococci are difficult to eradicate from middle ear fluid (MEF) and the nasopharynx (NP). Bacteriologic eradication from the NP and MEF during acute otitis media (AOM) by 3 common antibiotic drugs was prospectively evaluated. In 19 (16%) of 119 MEF culture-positive patients, an organism susceptible to the treatment drug (Haemophilus influenzae, Streptococcus pneumoniae, or both) was isolated from the initial MEF, whereas resistant S. pneumoniae was present in the NP; in 9 (47%) patients, the initial resistant NP organism (identified by serotyping, resistance to the administered drug, and pulsed-field gel electrophoresis) replaced the susceptible MEF organism within only a few days after initiation of treatment. In regions where resistant pneumococci are prevalent, antibiotics may not only fail to eradicate the organisms, but they may often induce MEF superinfection with resistant pneumococci initially carried in the NP. This is an important mechanism by which, in recently treated patients, AOM infections often become refractory to treatment.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Child; Drug Resistance, Microbial; Drug Therapy, Combination; Ear, Middle; Female; Humans; Male; Nasopharynx; Otitis Media; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Superinfection; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the efficacy and safety of ciprofloxacin (CIP) oral suspension to trimethoprim/sulfamethoxazole (TMP/SMX) oral suspension among older women with acute urinary tract infections (UTIs).. Prospective, randomized, open-label, multicenter study of older women (age 65 and older).. Community and nursing home.. A total of 261 older women were evaluable for safety. Of these, 172 (86 community, 86 nursing home) were evaluable for clinical and bacteriological efficacy.. Patients were randomized to a 10-day regimen of either CIP (250 mg/5 mL twice daily) or TMP/SMX (160/800 mg/20 mL twice daily).. Clinical response 4 to 10 days posttherapy.. For the efficacy-valid population, posttherapy clinical resolution was statistically superior following CIP (97%) versus TMP/SMX (85%) (95% CI=2.0-21.3; P= .009). Eradication of pretreatment bacterial isolates posttherapy was also higher following CIP (95%) versus TMP/SMX (84%) (95% CI=2.7-21.3; P= .019). For the intent-to-treat population, posttherapy clinical resolution was significantly higher in the CIP group (96%) than in the TMP/SMX group (87%) (95% CI=0.2-16.7; P= .025). Safety was assessed in the intent-to-treat population and the incidence of drug-related adverse events were significantly lower following CIP (17%) than following TMP/SMX (27%) (P= .047). Premature discontinuation due to these events was also less prevalent with CIP than with TMP/SMX (2% vs 11%, respectively) (P= .004).. CIP suspension showed higher clinical success and bacteriological eradication rates than did TMP/SMX for both community-based and nursing home-residing older women with acute UTIs. Furthermore, CIP suspension was associated with significantly lower rates of adverse events and premature discontinuations compared with TMP/SMX suspension.

Topics: Acute Disease; Administration, Oral; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Female; Humans; Middle Aged; Nursing Homes; Outcome Assessment, Health Care; Prospective Studies; Suspensions; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Lyme arthritis in children and adolescents due to infection with Borrelia burgdorferi responds well to intravenous and oral antibiotics, but nonresponders have been described with all antibiotic regimens tested and a standard therapy has not yet been established. We examined causes of the failure of antibiotic treatment in the presence of persistent organisms and autoimmune mechanisms.. A prospective multicenter study was carried out in 55 children and adolescents with Lyme arthritis.. There were significant differences between younger and older patients with pediatric Lyme arthritis. Younger patients were more likely to have fever at the onset of arthritis and to have acute or episodic arthritis. Older patients were more likely to have chronic arthritis, higher levels of IgG antibodies to B. burgdorferi (by ELISA and immunoblot), and a longer interval between antibiotic treatment and the disappearance of arthritis. Of 51 patients followed for at least 12 months after initiation of antibiotic treatment, 24% retained manifestations of the disease including arthritis (8 patients) and arthralgias (4 patients). These patients were predominantly female (9/12) and were significantly older than patients without residual symptoms. Patients who had received intraarticular steroids prior to antibiotic treatment required significantly more courses of antibiotic treatment and the time required for disappearance of the arthritis was longer.. Pediatric Lyme arthritis is more benign in younger children. Lyme arthritis should be excluded as a possible cause of arthritis prior to the administration of intraarticular steroids.

Topics: Acute Disease; Adolescent; Anti-Inflammatory Agents; Arthritis, Infectious; Borrelia burgdorferi Group; Ceftriaxone; Child; Child, Preschool; Doxycycline; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Injections, Intra-Articular; Knee Joint; Lyme Disease; Male; Roxithromycin; Steroids; Synovectomy; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Bladder infections are very common in otherwise healthy women, and short-course antimicrobial treatment appears effective for many episodes of cystitis. This study reports the results of short-course ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole therapy.. We performed a randomized, double-blind study of the efficacy and safety of a 3-day course of oral ciprofloxacin 100 mg twice daily, ofloxacin 200 mg twice daily, or trimethoprim/sulfamethoxazole 160/800 mg twice daily in women with acute, uncomplicated, symptomatic lower urinary tract infection.. A total of 866 patients were enrolled, of whom 688 (79%) were evaluated for the efficacy of treatment (229 treated with ciprofloxacin, 228 treated with trimethoprim/sulfamethoxazole, and 231 treated with ofloxacin). The most frequent reason for exclusion was the failure to identify a pretreatment pathogen. The most commonly isolated pathogen was Escherichia coli (81%). Eradication of the pretreatment pathogen at the end of therapy occurred in 94% of ciprofloxacin, 93% of trimethoprim/sulfamethoxazole, and 97% of ofloxacin-treated patients. At follow-up evaluation at 4 to 6 weeks, recurrence rates (relapse or reinfection) were 11% in the ciprofloxacin, 16% in the trimethoprim/sulfamethoxazole, and 13% in the ofloxacin treatment group. Clinical success at the end of therapy was 93% in the ciprofloxacin, 95% in the trimethoprim/sulfamethoxazole, and 96% in the ofloxacin treatment groups. The frequency of all adverse events was 31% for ciprofloxacin, 41% for trimethoprim/sulfamethoxazole, and 39% for ofloxacin-treated patients (P = 0.03). Premature discontinuation of study drug due to an adverse event was more common in trimethoprim/sulfamethoxazole-treated patients (n = 9) compared with those given ciprofloxacin (n = 2) or ofloxacin (n = 1; P = 0.02).. Ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole had similar efficacy when given for 3 days to treat acute, symptomatic, uncomplicated lower urinary tract infection in women.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Double-Blind Method; Drug Administration Schedule; Female; Humans; Middle Aged; Ofloxacin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The study was undertaken to compare the safety and efficacy of twice-daily ciprofloxacin for 3 days with standard 7 day therapy with either co-trimoxazole or nitrofurantoin in the treatment of women with acute, uncomplicated urinary tract infections (UTI). This multicentre, prospective, randomized, double-blind trial compared oral ciprofloxacin (100 mg bd) for 3 days with co-trimoxazole (160/800 mg bd) or nitrofurantoin (100 mg bd) for 7 days. Bacteriological and clinical evaluations were performed at study entry, during therapy and 4-10 days and 4-6 weeks after the completion of therapy. The primary efficacy parameter was eradication of the causative organism 4-10 days following treatment. Of 713 women enrolled and evaluable for safety, 521 were evaluable for efficacy (168 ciprofloxacin, 174 co-trimoxazole, 179 nitrofurantoin). Escherichia coli (83%) was the most frequently isolated pathogen in all treatment groups. Bacteriological eradication was reported in 88% of ciprofloxacin patients, 93% of co-trimoxazole patients and 86% of nitrofurantoin patients. At the 4-6 week follow-up, ciprofloxacin had statistically significantly higher eradication rates (91%) than co-trimoxazole (79%; 95% confidence limit (CL) = -20.6%, -3.9%) and nitrofurantoin (82%; 95% CL = -17.1%, -0.9%). Clinical resolution 4-10 days after therapy and at the 4-6 week follow-up was similar among the three treatment groups. The overall incidence of treatment-emergent adverse events was not significantly different (P = 0.093) among the three drug regimens, although co-trimoxazole was associated with a greater number of adverse events than ciprofloxacin (P < or = 0.05). Ciprofloxacin also caused fewer episodes of nausea than either of the other agents (P < or = 0.01).

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Cystitis; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Middle Aged; Nitrofurantoin; Prospective Studies; Staphylococcal Infections; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

TREATMENT OF SINUSITIS: For both acute rhinosinusitis in patients with no past history where S. pneumoniae and H. influenzae are the main causal agents, or recurrent sinusitis in a chronic background where anaerobic bacteria are increasingly implicated, pristinamycin is one of the rare compounds which can be expected to be effective and is a treatment of choice for an empirical strategy. LOWER RESPIRATORY TRACT INFECTIONS: Besides high-risk subjects with non-microbiologically proven bronchial infection, where enterobacteriaceae could involve a pristinamycin is a useful alternative to the conventional strategy (i.e.: amoxicillin, macrolides and cotrimoxazole) in the treatment of LRT infection.

Topics: Acute Disease; Adult; Amoxicillin; Bronchial Diseases; Bronchitis; Female; Humans; Macrolides; Male; Respiratory Tract Infections; Rhinitis; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Virginiamycin

Topics: Acute Disease; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Humans; Otitis Media; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of ciprofloxacin was studied in the treatment of 50 women (the average age of 41.6 years) with acute noncomplicated cystitis. The drug was administered in a dose of 100 mg twice a day for 3 days. The reference group included 15 women with the same disease subjected to the routine therapy with cotrimoxazol in a dose of 8 mg and pipemidic acid in a dose of 100 mg administered twice a day. The positive results evident from the subjective clinical improvement and no veritable bacteriuria were stated in 46 patients (92 per cent). The effect was at the average observed in 36 hours in the ciprofloxacin group while in the reference group it was at the average stated in 81.2 hours from the treatment start.

Topics: Acute Disease; Adult; Anti-Infective Agents; Anti-Infective Agents, Urinary; Bacteriuria; Ciprofloxacin; Cystitis; Female; Humans; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Humans; Male; Maxillary Sinusitis; Recurrence; Reproducibility of Results; Research Design; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women.. A prospective randomized trial with a cost analysis.. Women with acute cystitis attending a student health center.. Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily.. Six weeks after treatment, 32 (82%) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P = .04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 treated with cefadroxil (P = .11 vs trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P = .11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P = .05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14%; P = .11 vs trimethoprim-sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin-susceptible strains in the nitrofurantoin group. Trimethoprim-sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving trimethoprim-sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155).. A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli in the rectum, urethra, and vagina.

Topics: Acute Disease; Adult; Amoxicillin; Anti-Infective Agents; Cefadroxil; Confidence Intervals; Costs and Cost Analysis; Cystitis; Drug Administration Schedule; Female; Humans; Nitrofurantoin; Ofloxacin; Prospective Studies; Rectum; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Vagina

To compare 14-day outcomes and relapse and recurrence rates among patients with acute maxillary sinusitis randomized to 3-day (3D) vs 10-day (10D) treatment with trimethoprim/sulfamethoxazole (TMP/SMX).. University-affiliated Veterans Affairs general medical and acute care clinics.. Consecutive patients with sinus symptoms and radiographic evidence of maxillary sinusitis (complete opacity, air-fluid level, or > or = 6 mm of mucosal thickening). Patients were excluded for antibiotic use within the past week, TMP/SMX allergy, symptoms for more than 30 days, or previous sinus surgery.. All subjects (n = 80) received oxymetazoline nasal spray 0.05%, two sprays twice daily for 3 days. Subjects were randomly assigned to TMP/SMX double strength: one tablet twice daily for 10 days or one tablet twice daily for 3 days followed by 7 days of placebo. At 7 and 14 days, patients rated their overall sinus symptoms on a Likert scale. Radiographs were scored at baseline and 14 days by radiologists masked to clinical symptoms and treatment assignment. The primary outcome was number of days to "cure" or "much improvement" in sinus symptoms. Patients who were clinical successes by day 14 were assessed for symptomatic relapse or recurrence at 30 and 60 days, respectively.. Groups were comparable at randomization: male, 100%; black, 53%; median age, 48 years (interquartile range, 41 to 63 years); symptom duration, 10 days (interquartile range, 6 to 17 days); bilateral maxillary disease, 51%; and radiograph score, 4 (interquartile range, 2 to 4). Outcome assessment was completed in 95% of patients at day 14 (n = 76). Medication side effects and use of nonstudy sinus medications were equal between groups. By 14 days, 77% of 3D subjects and 76% of 10D subjects rated their sinus symptoms as cured or much improved (95% confidence interval for difference, -15% to 17%). Median days to cure/much improvement were 5.0 and 4.5 for the 3D and 10D groups, respectively; distributions of time to cure were not different (P = .34). Radiograph scores improved in both groups compared with baseline (2 points; P < .001), but improvement did not differ between groups (P = .31). Eight percent of 3D subjects and 13% of 10D subjects missed work due to sinus symptoms. Of the 52 patients who were clinical successes at 14 days and completed follow-up, three (11%) of 27 3D subjects and one (4%) of 25 10D subjects relapsed symptomatically by day 30; one (4%) of 27 3D subjects and one (4%) of 25 10D subjects suffered symptomatic recurrence between days 30 and 60 (P = .45 for the relapse and recurrence rates combined).. At the 2-week follow-up, clinical symptoms and radiograph scores improved equally following 3 or 10 days of TMP/SMX plus oxymetazoline nasal spray. Symptomatic relapse and recurrence were similar between groups. Three days of antibiotics were as effective as 10 days and, because of the high disease prevalence, hold the potential for substantial cost savings.

Topics: Acute Disease; Adult; Drug Administration Schedule; Humans; Male; Maxillary Sinusitis; Middle Aged; Oxymetazoline; Proportional Hazards Models; Radiography; Recurrence; Survival Analysis; Trimethoprim, Sulfamethoxazole Drug Combination

A community-based prospective surveillance and case management study of acute respiratory infection (ARI) in children aged 2-60 months of age was carried out over a 12-month period in Pakata, a semi-urban community in Ilorin, Kwara State, Nigeria. A cohort of 481 children was followed by trained community health assistants with thrice weekly home visits to record all symptoms and signs of ARI, and institute treatment based on WHO recommendations. There were three episodes of mild, moderate, or severe ARI per child per year, including 1.3 pneumonia episodes per child per year. The peak of infection corresponded to the rainy season (July-November), and a smaller peak to the dry season (February-April). Most of the health worker decisions were considered appropriate, although there was a tendency toward over-treatment with antibiotic drugs. An effective referral system was established from the community to a tertiary centre. There were no ARI-related deaths during the study period. These data indicate that a system of case management using trained community health workers can improve case management of ARI and may prevent severe ARI-related disease and deaths.

Topics: Acute Disease; Child, Preschool; Cloxacillin; Cohort Studies; Community Health Services; Female; Gentamicins; Health Promotion; Home Care Services; Humans; Infant; Male; Managed Care Programs; Nigeria; Pleural Effusion; Pneumonia, Staphylococcal; Prospective Studies; Respiratory Tract Infections; Severity of Illness Index; Staphylococcus aureus; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination; Workforce; World Health Organization

In a prospective randomized double-blind trial, pivmecillinam was compared with cotrimoxazole (TMP-SMX), both given orally for a period of 5 days, for the treatment of 59 children with shigellosis. 29 patients were treated with pivmecillinam and 30 with cotrimoxazole. 14% of shigella organisms isolated were resistant to pivmecillinam and 21% to TMP-SMX. The diarrhea persisted for a mean (+/- SD) period of 74 +/- 24.8 h in the pivmecillinam-treated patients versus 73.8 +/- 34 h in the TMP-SMX-treated patients. Duration of fever, positive stool culture, visible blood, occult blood, and pus cells in the stools were similar for both treatment groups. Five patients (17%) in the pivmecillinam group and 4 patients (13%) in the cotrimoxazole group fulfilled the clinical criteria that defined treatment failure. One patient (3.4%) in the pivmecillinam group and 2 (6.6%) in the TMP-SMX group evidenced recurrence of the diarrheal symptoms at the follow-up visit. No major drug-related side effects were observed in either group. We concluded that pivmecillinam is equivalent to cotrimoxazole in the treatment of shigellosis in children.

Topics: Acute Disease; Adolescent; Amdinocillin Pivoxil; Child; Child, Preschool; Double-Blind Method; Dysentery, Bacillary; Female; Humans; Infant; Male; Prospective Studies; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

Despite widespread use of trimethoprim-sulfamethoxazole (TMP-SMZ) for prophylaxis in neutropenic patients, questions remain regarding its efficacy, toxicity, the risk of selection of resistant isolates, and the relation of its activity to selective decolonization vs. the attainment of direct inhibitory levels within blood and tissues. We evaluated the effect of TMP-SMZ (160/800 mg orally every 12 hours) in 42 adult granulocytopenic patients (< 100 absolute neutrophils/mm3, mean duration 13.3 days) undergoing chemotherapy for acute leukemia at 11 participating Veterans Administration Medical Centers in a randomized, double-blind, placebo-controlled trial. No significant differences in survival, frequency of bacteremia, overall infections, use of systemic antimicrobial therapy, or adverse effects, including myelosuppression, were observed between patients receiving TMP-SMZ vs. those receiving placebo. All patients acquired trimethoprim-resistant organisms. Concentrations of trimethoprim in serum were significantly lower before febrile episodes than when patients were afebrile. These results suggest that the purported activity of TMP-SMZ may be related to the serum concentration achieved. Moreover, the results highlight the need for additional study of the value of antibiotic prophylaxis in neutropenic patients.

Topics: Acute Disease; Adult; Agranulocytosis; Bacterial Infections; Double-Blind Method; Female; Humans; Leukemia; Male; Middle Aged; Prospective Studies; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The role of ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMZ) was evaluated in empiric treatment of uncomplicated Salmonella enteritis in a comparative, double-blind trial. Patients were randomized to receive ciprofloxacin (500 mg), TMP-SMZ (160/800 mg), or placebo orally twice daily for 5 days. There were 65 evaluatable patients with acute, uncomplicated, culture-confirmed Salmonella enteritis. Duration of diarrhea, abdominal pain, or vomiting and time to defervescence were not significantly different for patients treated with ciprofloxacin, TMP-SMZ, or placebo; there also were no significant differences with respect to full resolution of symptoms for ciprofloxacin versus placebo (point estimate, 0.2 days; 95% confidence interval [CI], -0.5 to 0.9 days) or for TMP-SMZ versus placebo (point estimate, 0.2 days; 95% CI, -1.0 to 0.6 days). The rate of clearance of salmonellae from stools was not significantly different among the groups.

Topics: Acute Disease; Adult; Ciprofloxacin; Double-Blind Method; Drug Combinations; Enteritis; Feces; Female; Humans; Male; Middle Aged; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

In a multicentric study comparing oral single-dose therapy of fosfomycin trometamol (3 g as fosfomycin) versus co-trimoxazole (1.92 g) or ofloxacin (200 mg) as many as possible of the pathogens were sent to and analysed in a central laboratory. The pathogens were identified and minimal inhibitory concentrations (MIC) of fosfomycin, trimethoprim alone and in combination with sulfamethoxazole, ofloxacin, ampicillin, amoxicillin combined with clavulanic acid, and cephadroxil were determined. The eradication of pathogens (cfu < 10(3)/ml at one week after single-dose therapy) was analysed according to species and MIC of the antibiotic used. Urine cultures of 349 patients were analysed. Escherichia coli was the predominating species followed by staphylococci and Proteus mirabilis. Enterococci were mostly found in mixed culture. Baseline pathogens of monoinfections were eradicated in 87.1%, in 88.9% and in 86.4% of 284 patients treated with fosfomycin trometamol, co-trimoxazole and ofloxacin, respectively. The MICs of the five antibacterial agents and the two antibiotic combinations for 253 baseline pathogens showed that of the E. coli strains none was resistant to ofloxacin, three (MIC = 128 mg/l) were resistant to fosfomycin, 3.6% to co-trimoxazole, 6.2% to trimethoprim, 8.8% to ampicillin, and 5.7% to amoxicillin/clavulanic acid. The eradication rates according to the MICs of the corresponding drugs showed equally good eradication rates for fosfomycin up to an MIC of 64 mg/l. Above this level two out of three strains were also eradicated by fosfomycin trometamol. For co-trimoxazole and ofloxacin no intermediately sensitive or resistant strains were found. Within the range of MICs found there were equally good eradication rates for both antibacterial agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adolescent; Adult; Aged; Drug Administration Schedule; Female; Fosfomycin; Humans; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A total of 63 adult patients with uncomplicated acute pyelonephritis were enrolled in a multicenter, randomized comparison of lomefloxacin (400 mg orally once daily for 14 days) and trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg orally twice daily for 14 days). Study participants were predominantly female (70% in the lomefloxacin group and 80% in the TMP/SMX group). Escherichia coli was isolated from pretreatment urine cultures in 87.5% of the lomefloxacin group and 80.0% of the TMP/SMX group. Baseline pathogens were eradicated in 100% of evaluable patients in the lomefloxacin group 5-9 days after the end of therapy and in 88.9% of patients in the TMP/SMX group (p = 0.05). The clinical cure rate 5-9 days after therapy with lomefloxacin was 65.0% and for TMP/SMX was 68.4%. At the 4-6 week follow-up in the lomefloxacin group, nine pathogens remained eradicated, one E. coli was isolated, and the results for 14 pathogens were unknown or unevaluable. In the TMP/SMX group, 12 pathogens remained eradicated, three E. coli and one Group D Streptococcus were isolated, and the results for nine pathogens were unknown or unevaluable. Both treatment regimens were well tolerated; adverse events occurred in 12% of patients in the lomefloxacin group and in 17% in the TMP/SMX group. Events considered by the investigators to be probably related to treatment occurred in three patients in each group. In conclusion, once-daily lomefloxacin (400 mg) was a well tolerated and effective alternative to twice-daily TMP/SMX (160/800 mg) for the treatment of adults with uncomplicated acute pyelonephritis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Pyelonephritis; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To explore the optimal dosing regimen for trimethoprim-sulfamethoxazole (TMP-SMX) when used in combination with loperamide to treat traveler's diarrhea, 190 U.S. adults with acute diarrhea were enrolled in a double-blind, randomized trial in Guadalajara, Mexico. All patients received loperamide (4-mg loading dose; 2 mg after each loose stool, not to exceed 16 mg/day for 3 days) and were randomized to receive a 3-day course of TMP-SMX (160:800 mg twice daily for six doses) (group A), a single large dose of TMP-SMX (320:1,600 mg) (group B), or a large loading dose (320:1,600 mg) followed by standard doses for 3 days (160:800 mg twice daily for five doses) (group C). Patients in group C responded best (P < 0.01), with 75% of subjects recovered from diarrhea in 12 h compared with 34 h (group A) and 33 h (group B). Similar differences in favor of group C were noted in the subset of patients who presented with moderate to severe diarrhea. On average, patients in group C took significantly (P < 0.05) less loperamide (1.2 mg) after the 4-mg loading dose compared with patients in group A (2.4 mg) or group B (2.0 mg). We conclude that the most efficacious treatment of traveler's diarrhea in the interior of Mexico is to take loperamide in usual doses to control symptoms in combination with a single large dose of TMP-SMX, which should then be continued for 3 days in standard doses.

Topics: Acute Disease; Adult; Diarrhea; Double-Blind Method; Drug Administration Schedule; Drug Interactions; Female; Humans; Loperamide; Male; Prospective Studies; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

A randomized treatment trial of travelers' diarrhea was carried out among U.S. military personnel participating in routine exercises in several port cities in South America and West Africa. A 5-day, twice daily course of either norfloxacin (400 mg) or trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg) was given to 142 volunteers. At the end of 5 days of treatment, diarrhea had resolved in 100% of 73 patients receiving norfloxacin and 97.1% (67/69) receiving TMP/SMX. A probable bacterial pathogen was determined in 44% of 142 subjects: 49% of the norfloxacin group and 39% of the TMP/SMX group. The most common pathogens detected were enterotoxigenic Escherichia coli in 20% of cases and rotavirus in 15%. Resistance to TMP/SMX was present in 20 (27%) bacterial isolates, while no resistance to norfloxacin was found. Eight of 10 patients in the TMP/SMX treatment group who had TMP/SMX-resistant bacterial enteropathogens improved clinically. Both norfloxacin and TMP/SMX were clinically effective in the treatment of travelers' diarrhea in this military population.

Topics: Acute Disease; Adolescent; Adult; Africa, Western; Bacterial Infections; Diarrhea; Escherichia coli Infections; Feces; Humans; Male; Middle Aged; Military Personnel; Norfloxacin; South America; Surveys and Questionnaires; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Virus Diseases

In randomized, double-blind trials of antibiotic therapy for acute otitis media that determined both clinical and bacteriologic outcomes, clinical success rates were (93%) 236 of 253 for patients with bacteriologic success, (62%) 25 of 40 for those with bacteriologic failure, and (80%) 124 of 155 for those with nonbacterial acute otitis media. These rates were used to calculate the effectiveness of three strategies for assessing drug efficacy: (1) tympanocentesis and culture before and during therapy (bacteriologic efficacy), (2) tympanocentesis before therapy and assessment of clinical efficacy in bacterial acute otitis media, and (3) no tympanocentesis and assessment of clinical efficacy in clinical (total) acute otitis media. For a drug with a bacteriologic efficacy of 100%, calculated clinical efficacy was 93% for bacterial acute otitis media and 89% for clinical acute otitis media. For a drug with bacteriologic efficacy of 27%, a rate consistent with no antibacterial therapy, efficacy was 71% for bacterial acute otitis media and 74% for clinical acute otitis media. We conclude that if efficacy is measured by symptomatic response, drugs with excellent antibacterial activity will appear less efficacious than they really are and drugs with poor antibacterial activity will appear more efficacious than they really are. The predominant phenomenon is that drugs with poor antibacterial activity will appear to be clinically effective in the treatment of acute otitis media.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Cefaclor; Cefixime; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Double-Blind Method; Drug Combinations; Efficiency; Enzyme Inhibitors; Female; Haemophilus influenzae; Humans; Infant; Male; Moraxella catarrhalis; Otitis Media; Punctures; Streptococcus pneumoniae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tympanic Membrane

The efficacy of co-trimoxazole for the treatment of Plasmodium falciparum parasitaemia in children younger than 5 years of age was evaluated in Malawi. 46 children with P falciparum parasitaemia, 37% of whom also met clinical criteria for a diagnosis of acute lower respiratory tract infection, were treated with 20 mg/kg co-trimoxazole twice daily for five days. Parasitaemia (mean clearance time 2.7 days) and symptoms were rapidly abolished and improvement was maintained during follow-up for 14 days. Co-trimoxazole may be an effective single treatment for febrile illness in young children in areas where malaria is endemic, resources are few, and diagnosis must rely on clinical findings alone.

Topics: Acute Disease; Animals; Child, Preschool; Drug Administration Schedule; Drug Evaluation; Fever; Humans; Infant; Lung Diseases, Parasitic; Malaria; Malawi; Plasmodium falciparum; Prevalence; Respiratory Tract Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We compared the safety and efficacy of a single 400-mg dose of ofloxacin, ofloxacin (200 mg) once daily for 3 days, and trimethoprim-sulfamethoxazole (160:800 mg) twice daily for 7 days for the treatment of acute uncomplicated cystitis (urinary tract infection [UTI]) in women. At 5 weeks posttreatment, 35 (81%) of 43 patients treated with single-dose ofloxacin, 40 (89%) of 45 treated with 3 days of ofloxacin, and 41 (98%) of 42 treated with trimethoprim-sulfamethoxazole were cured (P = 0.03, single-dose ofloxacin group versus trimethoprim-sulfamethoxazole group). Retreatment for symptomatic recurrent UTI was given to 7 (16%) of 43 patients initially treated with single-dose ofloxacin, 3 (7%) of 45 patients treated with 3 days of ofloxacin, and 0 of 42 patients treated with trimethoprim-sulfamethoxazole (P = 0.01, single-dose ofloxacin group versus trimethoprim-sulfamethoxazole group). There was a trend in each of the three treatment groups toward an association between persistent or recurrent episodes of significant bacteriuria and a history of UTI in the past year and with diaphragm use. Ofloxacin was more effective than trimethoprim-sulfamethoxazole in eradicating Escherichia coli from rectal cultures during or soon after therapy, but there were no differences at later follow-up visits. Adverse effects were equally common among the three treatment groups. We conclude that single-dose ofloxacin was less effective than 7 days of trimethoprim-sulfamethoxazole for treatment of uncomplicated cystitis in women, while the 3-day ofloxacin regimen and the trimethoprim-sulfamethoxazole regimen were not significantly different in efficacy.

Topics: Acute Disease; Adult; Cystitis; Female; Humans; Ofloxacin; Perineum; Rectum; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of the traditionally recommended ampicillin (Amp) plus gentamicin (GM) regimen was compared with that of a trimethoprim-sulfamethoxazole (TMP/SMZ)-plus-GM regimen and the adequacy of 14 days total therapy for acute uncomplicated pyelonephritis (AUPN). Eighty-five women hospitalized for AUPN were randomly assigned to receive either Amp, 1 g intravenously (iv) every 6 h for 3 days, then 500 mg orally four times daily, or TMP/SMZ, 160/800 mg iv every 12 h for 3 days, then 160/800 mg orally twice daily. Initially, all patients also received GM every 8 h iv (mean, 606 doses). Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P less than .001). Both regimens produced a satisfactory bacteriologic and clinical response in all cases. Reinfection occurred in 11% of Amp and in 8% of TMP/SMZ recipients. No patient experienced relapsing infection. The TMP/SMZ regimen was less costly and less likely to require modification due to antimicrobial resistance.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Ampicillin; Drug Therapy, Combination; Female; Gentamicins; Humans; Middle Aged; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination

A total of 60 patients with lower respiratory tract or urinary tract infections were enrolled in an open, randomized, controlled, parallel study comparing 300 mg ofloxacin (OFX) b.i.d. with trimethoprim + sulfamethoxazole (TMP 800 mg + SMX 160 mg), 1 tablet, b.i.d. The signs and symptoms of low respiratory tract infection were cured in 12 patients (80%) of the OFX group and improved in 2 other patients (13%); at the end of therapy, the 2 germs that persisted were Streptococcus pneumoniae and Branhamella catarrhalis. Clinical cure was achieved in 13 patients (86%) in the TMP-SMX group, while 2 patients were considered as failures (14%); after therapy, the 3 organisms that persisted were 2 S. pneumoniae and 1 Pseudomonas aeruginosa. As far as urinary tract infections are concerned clinical cure and complete eradication of bacteria were achieved in 14 patients in the OFX group (93%); the germ that persisted was Escherichia coli (100,000 CFU), but the patient was asymptomatic. In patients of the TMP-SMX group the urinary infections were cured in 11 subjects (73%); the germs that persisted were 2 E. coli and 1 Proteus mirabilis. Adverse effects were reported for 3 patients (10%) in the OFX group and 4 patients (13%) in the TMP-SMX group. The measurement of serum and intracellular (polymorphonuclear cells and lymphocytes) levels of OFX and TMP-SMX and the assessment of the host's immunocompetence ruled out the possibility of any immunotoxicological side effect.

Topics: Acute Disease; Aged; Bronchitis; Bronchopneumonia; Chronic Disease; Cystitis; Escherichia coli; Female; Haemophilus influenzae; Humans; Klebsiella pneumoniae; Male; Middle Aged; Ofloxacin; Pyelitis; Remission Induction; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Topics: Acute Disease; Anti-Bacterial Agents; Ciprofloxacin; Colistin; Drug Therapy, Combination; Humans; Infection Control; Infections; Leukemia; Multicenter Studies as Topic; Neutropenia; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild (16/64), a moderate (26/64), or a severe (22/64) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3-6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36/64 (56%) (9/16 with a mild form, 13/26 with moderate form and 14/22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15/64 (23%) (5/16 with a mild form, 4/26 with a moderate form and 6/22 with a severe form of the disease). Oviductal cultures for CT were found in 12/64 (19%) (1/16 with a mild form, 4/26 with a moderate and 7/25 with severe form of salpingitis). Oviductal isolates for NG were found in 2/64 (13%) (2/16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Topics: Acute Disease; Adolescent; Adult; Bacteria; Cervix Uteri; Doxycycline; Drug Combinations; Drug Therapy, Combination; Fallopian Tubes; Female; Humans; Laparoscopy; Penicillin G Procaine; Prospective Studies; Random Allocation; Salpingitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of cefaclor and of trimethoprim-sulfamethoxazole (TMP-SMX) in the management of recurrent otitis media was evaluated in a randomized single-blind controlled trial. The median age of the patients was 12 months (range 5-37); there were 37 boys and 19 girls. All had received 1 or more courses of antibacterials for acute otitis media in the previous 2-3 weeks. 27 were treated with oral cefaclor suspension, 40 mg/kg/day in 3 divided doses, and 29 with 1 mg/kg/day of TMP-SMX (trimethoprim 8 mg, sulfamethoxazole 40 mg) in 2 divided doses, each group for 10 days. 70% of the cefaclor group and 90% of the TMP-SMX group were cured after the 10 days of therapy (0.1 greater than p greater than 0.05). Results were not better on the 21st day as compared with the 10th. Our data indicate a mild preference for TMP-SMX (although p was not less than 0.05), since it needs to be given only twice a day and costs less than cefaclor.

Topics: Acute Disease; Cefaclor; Cephalexin; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Male; Otitis Media; Randomized Controlled Trials as Topic; Recurrence; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

We compared the safety and efficacies of ofloxacin and trimethoprim-sulfamethoxazole for the treatment of acute uncomplicated cystitis in women enrolled in a multicenter study. Data from three centers were combined for this report because the study design and study populations were identical, and patients were enrolled within an 18-month period. Cure rates for evaluable patients 4 weeks after treatment were high for all regimens: ofloxacin (200 mg) twice daily for 3 days, 22 of 25 (88%) cured; ofloxacin (200 mg) twice daily for 7 days, 42 of 49 (86%) cured; ofloxacin (300 mg) twice daily for 7 days, 25 of 25 (100%) cured; and trimethoprim-sulfamethoxazole (160/800 mg) twice daily for 7 days, 46 of 52 (88%) cured. Ofloxacin was more effective than trimethoprim-sulfamethoxazole in eradicating Escherichia coli from rectal cultures during and 1 week after treatment. Both ofloxacin and trimethoprim-sulfamethoxazole markedly reduced vaginal colonization with E. coli during and 4 weeks after therapy. Emergence of resistant coliforms in rectal flora was found in 5 (19%) of 27 patients treated with trimethoprim-sulfamethoxazole but none of 50 ofloxacin-treated patients who were studied (P = 0.004). Adverse effects were equally common among the four treatment groups. We conclude that 3 to 7 days of ofloxacin is as safe and effective as trimethoprim-sulfamethoxazole for treatment of uncomplicated cystitis in women and that ofloxacin effectively reduces the fecal and vaginal reservoirs of coliforms in such patients.

Topics: Acute Disease; Adult; Cystitis; Drug Resistance, Microbial; Feces; Female; Humans; Ofloxacin; Perineum; Rectum; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To have their diagnosis verified, etiology determined and treatment evaluated, 64 patients with a suspected acute salpingitis underwent laparoscopy during which isolates were taken. The patients were then randomized to one of two groups for treatment; doxycycline/benzylpenicillin procaine (DC + BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated three to six months later by second look laparoscopy when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 37 (58%) patients and for Neisseria gonorrhoeae (NG) in 15 (23%). Isolates from the oviducts were positive in 17 (27%) patients of whom 12 had CT and two had NG. Mild salpingitis (Grade I) was found in 16 patients, moderate (Grade II) in 26 and severe (Grade III) in 22 patients. At second look laparoscopy, two patients had totally occluded oviducts, 31 had adhesions but tubal passage on at least one side while 31 patients had healed without any signs of residue. Results at second look laparoscopy showed no statistical difference between the two treatment groups.

Topics: Acute Disease; Adolescent; Adult; Clinical Trials as Topic; Doxycycline; Drug Combinations; Drug Therapy, Combination; Female; Humans; Laparoscopy; Penicillin G; Penicillin G Procaine; Random Allocation; Reoperation; Salpingitis; Sulfamethoxazole; Surgical Procedures, Operative; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The bacteriological and clinical efficacy of norfloxacin 400 mg b.i.d. was compared to those of co-trimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) b.i.d. and placebo b.i.d. for the treatment of acute bacterial diarrhoea in a randomized double-blind trial. Of a total of 450 patients with acute diarrhoea, 303 had positive bacterial cultures and were evaluable for efficacy. The time to elimination of pathogens was significantly (p less than 0.001) shorter in the norfloxacin group than in the co-trimoxazole and placebo groups. At completion of treatment, bacteriological cure was found in 97.9%, 72.4% and 38.2% of patients treated with norfloxacin, co-trimoxazole and placebo, respectively. All pathogens were susceptible to norfloxacin and none of them developed resistance to norfloxacin during treatment. In the co-trimoxazole group, resistance to that antibiotic increased from 2% at inclusion to 65.6% at the end of treatment (p less than 0.001). In patients with shigellosis or cholera, the mean time to normalization of bowel movements was significantly shorter in the norfloxacin and co-trimoxazole groups than in the placebo group (p less than 0.05 and p less than 0.01, respectively). There were no significant differences between groups with respect to adverse events reported. In conclusion, norfloxacin was well tolerated and highly effective in the treatment of acute bacterial diarrhoea.

Topics: Acute Disease; Adult; Bacterial Infections; Clinical Trials as Topic; Diarrhea; Double-Blind Method; Drug Combinations; Drug Resistance, Microbial; Female; Humans; Male; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A total of 63 neutropenic patients receiving cytotoxic therapy for acute leukemia were randomly allocated to receive norfloxacin (400 mg every 12 hours) or cotrimoxazole (160/800 mg every 12 hours) to prevent bacterial infection. Compliance was more than 95 percent and no adverse effects attributable to the study drugs were observed. The overall incidence of febrile illness (67 percent) was similar between the groups; however, no gram-negative bacillary infections were observed in 31 norfloxacin recipients compared with four of 32 cotrimoxazole recipients. Furthermore, nine norfloxacin recipients had 17 gram-positive bacteremias compared with two in two cotrimoxazole recipients (p = 0.0034). Norfloxacin was more effective than cotrimoxazole for preventing acquisition of aerobic gram-negative bacilli in surveillance cultures. Neither study drug allocation nor the presence of an indwelling central venous catheter influenced outcome among the 42 patients who subsequently received empiric systemic antibiotics for suspected infection. Although gram-positive infection remains an unsolved problem, norfloxacin appears to be a safe, effective, well-tolerated alternative to cotrimoxazole for preventing gram-negative infection in neutropenic patients with acute leukemia.

Topics: Acute Disease; Adult; Antineoplastic Agents; Bacterial Infections; Clinical Trials as Topic; Drug Combinations; Female; Gram-Negative Bacteria; Humans; Leukemia; Male; Neutropenia; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

One hundred thirty-two children with acute urinary tract infection were randomly assigned to receive trimethoprim-sulfamethoxazole in one dose, two doses daily for 3 days or two doses daily for 7 days. The patient characteristics, etiologic agents and frequency of roentgenologic abnormalities were similar for the three treatment groups. There was no significant difference in bacteriologic cure rates for the single dose regimen (93%) and multidose regimens (96%). The difference in rates of recurrent urinary tract infection between the single dose (20.5%) and 3-day (5.6%) and 7-day (8%) regimens was statistically significant (P = 0.033). A single dose of trimethoprim-sulfamethoxazole is inadequate treatment for infants and children with acute urinary tract infection.

Topics: Acute Disease; Child; Child, Preschool; Costa Rica; Drug Administration Schedule; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Female; Follow-Up Studies; Humans; Infant; Male; Random Allocation; Recurrence; Specimen Handling; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography

Topics: Acute Disease; Adult; Anti-Infective Agents; Ciprofloxacin; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Humans; Infection Control; Leukemia; Neomycin; Neutropenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In studies conducted in seven countries, 392 persons with acute diarrhea were enrolled and randomly assigned to one of three regimens. In order to compare the effectiveness of various therapies for acute gastroenteritis, patients were treated for five days with either norfloxacin, 400 mg twice daily, norfloxacin, 400 mg three times a day, or trimethoprim/sulfamethoxazole, (160 mg/800 mg) twice daily. Clinical cure occurred in 89 percent (lower dose) and 91 percent (higher dose) of those treated with norfloxacin, compared with 78 percent of those receiving trimethoprim/sulfamethoxazole; cure rates in each treatment group were greater when the patient's stool contained fecal leukocytes. In 105 of 106 (99 percent) patients treated with either dose of norfloxacin and in 49 of 52 (94 percent) trimethoprim/sulfamethoxazole-treated subjects, the bacterial enteropathogen identified in the pretreatment stool was eradicated on the posttreatment specimen. Two percent (two patients) of those receiving the lower dose of norfloxacin, 3 percent (two patients) of those receiving trimethoprim/sulfamethoxazole, and 4 percent (three patients) of those receiving the higher dose of norfloxacin experienced minor and transient adverse hematologic or blood chemistry reactions. In addition, mild cutaneous reactions that were attributed to the study medications developed in two patients receiving the higher dose of norfloxacin and in three patients who received trimethoprim/sulfamethoxazole. These studies indicate that norfloxacin is safe and effective therapy for bacterial diarrhea.

Topics: Acute Disease; Adult; Child; Clinical Trials as Topic; Diarrhea; Drug Combinations; Feces; Humans; Microbial Sensitivity Tests; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Chile; Clinical Trials as Topic; Drug Combinations; Female; Humans; Nitrofurantoin; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The clinical and bacteriological efficacy and adverse reactions of ofloxacin vs trimethoprim-sulphamethoxazole were investigated in a double-blind, randomised study in 250 female patients (125 in each group) with acute, uncomplicated lower urinary tract infections. The dosages of ofloxacin and trimethoprim-sulphamethoxazole were 100mg and 160mg + 800mg twice daily, respectively. The duration of therapy was 3 days. 81% of the patients had significant bacteriuria. Escherichia coli was isolated in 76% and Staphylococcus saprophyticus in 11% of the infections. The bacteriological elimination, clinical cure and improvement rates of the evaluable patients on ofloxacin treatment were 92 and 95%, respectively. The corresponding figures on trimethoprim-sulphamethoxazole therapy were 88 and 90%. Adverse reactions were clinically unimportant, and none of the patients had to stop treatment. Mild and transient side effects, mainly from the gastrointestinal tract, central nervous system and skin, were reported by 19 and 22% of the patients in the ofloxacin and trimethoprim-sulphamethoxazole groups, respectively. None of the differences in clinical and bacteriological efficacy and side effects of ofloxacin vs trimethoprim-sulphamethoxazole were statistically significant. Ofloxacin appears to be an appropriate antibiotic for short term therapy of acute, uncomplicated, lower urinary tract infections, comparing favourably with trimethoprim-sulphamethoxazole treatment in this study.

Topics: Acute Disease; Anti-Infective Agents; Cystitis; Drug Combinations; Female; Humans; Infant, Newborn; Microbial Sensitivity Tests; Ofloxacin; Oxazines; Pregnancy; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with acute nonlymphocytic leukemia were randomized to receive remission induction therapy consisting of seven days of cytosine arabinoside and three days of daunorubicin ("7 + 3") or to receive the same regimen intensified by either the addition of 6-thioguanine or by extension of the administration of cytosine arabinoside to ten days. Additionally, all patients were randomized to receive or not to receive cotrimoxazole antibacterial prophylaxis during the remission induction phase. Neither an increase in intensity of chemotherapy nor the antibacterial prophylaxis increased the remission rate above the 53% for patients treated with the standard "7 + 3" regimen. The second part of this study addressed the issue of the utility of long-term maintenance chemotherapy. To this end, patients were randomized to discontinue all treatment after 8 months of maintenance chemotherapy or to continue maintenance therapy for a total of 3 years. Although there was a transient increase in the relapse rate for patients who discontinued therapy, the proportion of long-term remitters was identical in the two patient groups. Additionally, there is a suggestion of a survival advantage for patients randomized to discontinue all therapy at 8 months.

Topics: Acute Disease; Clinical Trials as Topic; Cytarabine; Daunorubicin; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Humans; Leukemia; Prognosis; Random Allocation; Remission Induction; Research Design; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A single blind prospective study was undertaken with 74 patients suffering from acute bronchitis, taken from general practice and one geriatric ward. Half were randomly allocated to treatment with 200 mg trimethoprim twice a day and the other half with 160 mg trimethoprim plus 800 mg sulphamethoxazole twice a day; both therapies were used for 7 days. We found little difference in the clinical or bacteriological responses to the different regimens although the higher concentration of trimethoprim in the single therapy gave a slightly more successful eradication of Haemophilus spp. Resistant bacteria appeared during and after therapy in a few cases but this was a greater problem with the sulphamethoxazole-containing preparation.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis; Drug Combinations; Drug Evaluation; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Clinical Trials as Topic; Cystitis; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy and safety of amoxicillin-clavulanic acid were compared with those of co-trimoxazole in the treatment of acute urinary tract infections. A total of 104 patients (mean age, 52 years) with clinical and laboratory evidence of acute urinary tract infection were enrolled in the study. Characteristics and infecting organisms were equivalent in both groups of patients. Escherichia coli was the predominant bacteria pathogen in both groups. Both drugs resulted in clinical improvement in 100% of the patients; bacteriological cure after the termination of therapy was 95% with amoxicillin-clavulanic acid and 83% with co-trimoxazole (P less than 0.001). Side effects were not severe enough to necessitate discontinuation of the antimicrobial agents. Amoxicillin-clavulanic acid is effective and safe therapy for acute urinary tract infections caused by susceptible bacteria.

Topics: Acute Disease; Adolescent; Adult; Aged; Amoxicillin; Anti-Infective Agents, Urinary; Clavulanic Acid; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a comparative study of infection prophylaxis, patients with acute leukemia receiving remission induction therapy were assigned either no prophylaxis, sulfamethoxazole and trimethoprim, ketoconazole, or the combination of sulfamethoxazole and trimethoprim and ketoconazole. Both sulfamethoxazole and trimethoprim and the combination of sulfamethoxazole and trimethoprim and ketoconazole substantially reduced the overall incidence of infection consequent to a marked decrease in bacterial infection. However, sulfamethoxazole and trimethoprim were associated with an increased rate of fungal infection, while ketoconazole decreased this complication. No form of prophylaxis reduced infectious mortality or increased the complete remission rate. However, because of its effect in reducing infectious morbidity, we conclude that patients with acute leukemia receiving remission induction treatment should be given antibacterial and antifungal prophylaxis.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Drug Combinations; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Humans; Ketoconazole; Leukemia; Middle Aged; Mycoses; Pneumonia; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Forty-three women with acute, symptomatic urinary tract infections were randomized to receive either norfloxacin (400 mg) twice daily or trimethoprim-sulfamethoxazole (160-800 mg) twice daily for 10 days. Of the 43 patients, 7 (16%) had low-count bacteriuria and pyuria and were included in the evaluation. Escherichia coli was isolated in 72% of the infections, whereas coagulase-negative staphylococci were isolated in 14%. All isolates were susceptible to the assigned study drug. The MICs for 90% of the strains susceptible to norfloxacin and trimethoprim-sulfamethoxazole were less than or equal to 2 and less than or equal to 0.8-16 micrograms/ml, respectively. The cure rates for norfloxacin and trimethoprim-sulfamethoxazole were 95 and 90%, respectively. There were 17 patients with presumptive upper tract infections; only 1 of these relapsed after therapy. The effects on the periurethral flora were similar in both groups, but the infecting organism was eradicated from the fecal flora in 93% of the patients treated with norfloxacin and in 57% of the patients treated with trimethoprim-sulfamethoxazole. More early reinfections occurred in the trimethoprim-sulfamethoxazole group, with resistant organisms appearing in urine and in the periurethral and fecal flora in all cases. Three patients in each group experienced adverse clinical effects, but these were more severe in the trimethoprim-sulfamethoxazole group. No adverse hematological or biochemical changes were noted. From these results, we concluded that norfloxacin is at least as effective as trimethoprim-sulfamethoxazole in the therapy of acute, symptomatic urinary tract infections in women.

Topics: Acute Disease; Adult; Aged; Anti-Infective Agents, Urinary; Bacteria; Drug Combinations; Feces; Female; Humans; Male; Middle Aged; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections

Forty-nine hospitalized patients with acute exacerbations of chronic bronchitis were randomly allocated a ten-day course of either pivmecillinam/pivampicillin or co-trimoxazole. Both treatments were equally effective clinically (pivmecillinam/pivampicillin successful in 72% of cases; co-trimoxazole in 70%) and in their ability to eradicate pus from sputum (pivmecillinam/pivampicillin 84%; co-trimoxazole 74%). One patient taking co-trimoxazole ceased therapy because of persistent nausea and vomiting. No side-effects were observed in the pivmecillinam/pivampicillin group.

Topics: Acute Disease; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Bronchitis; Candida; Drug Combinations; Drug Therapy, Combination; Female; Haemophilus; Humans; Male; Middle Aged; Pivampicillin; Pseudomonas; Random Allocation; Sputum; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Each of 201 men with symptoms and signs of acute urethritis was randomly assigned to one of two treatment regimens: ampicillin (2g) plus probenecid (1g), or sulphamethoxazole-trimethoprim (SMX-TMP) (sulphamethoxazole 1600 mg plus trimethoprim 320 mg) four tablets twice daily for two days. Before treatment Neisseria gonorrhoeae was isolated from 162 patients, while coexistent Chlamydia trachomatis was recovered from 42 (26%) men. After treatment N gonorrhoeae persisted in 11 (14.3%) of the 77 patients treated with ampicillin and probenecid and in three (3.5%) of the 85 treated with SMX-TMP (p less than 0.05), while C trachomatis persisted in four (16%) of the 25 men treated with SMX-TMP and in all 17 patients treated with ampicillin and probenecid. SMX-TMP was thus more effective than ampicillin in treating acute gonorrhoea in men and in eradicating concurrent C trachomatis infection.

Topics: Acute Disease; Ampicillin; Anti-Infective Agents, Urinary; Chlamydia Infections; Chlamydia trachomatis; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Gonorrhea; Humans; Male; Probenecid; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Environment, Controlled; Gentamicins; Humans; Leukemia; Neoplasms; Nystatin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

127 outpatients, 78 with acute purulent sinusitis and 49 with acute tonsillitis, were treated for 7 days with a benzylpyrimidine -sulphonamide combination. In this double-blind and randomized study 59 patients received co- tetroxazine (100 mg tetroxoprim and 250 mg sulphadiazine) b.i.d., whilst the reference substance, co-trimoxazole (160 mg trimethoprim and 800 mg sulphamethoxazole) was given to the remaining 68 patients b.i.d. The test criteria were the therapeutic efficacy and both subjective and objective tolerance. An improvement in clinical symptoms and signs occurred in both conditions under each therapeutic regimen. Clinical therapeutic success was rated very good or good in 96.6% treated with co- tetroxazine and in 97.1% of patients treated with co-trimoxazole. In the former group therapy failed in 1 patient with sinusitis and in 1 with acute tonsillitis . In 98.3% of patients treated with co- tetroxazine the tolerance was very good or good, whilst the respective figure for co-trimoxazole was only 91.2%. 6 patients suffered from side effects ( gastric spasm, gastralgia , nausea, vomiting, diarrhoea) which were so severe in 2 cases that treatment had to be prematurely terminated. The generally good tolerance to both preparations was confirmed by the results of the laboratory investigations.

Topics: Acute Disease; Adult; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Pyrimidines; Sinusitis; Sulfadiazine; Sulfamethoxazole; Tonsillitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacteria; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Epididymitis; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Neck Obstruction; Urinary Tract Infections; Urine

We performed a randomized controlled trial of cefaclor administered twice daily compared with trimethoprim-sulfamethoxazole (TMP-SMZ) administered twice daily for the treatment of acute otitis media. Pathogens were eradicated from the middle ear exudate after 3 to 6 days of therapy in 35 of 37 (95%) patients given TMP-SMZ compared with 28 of 40 (70%) given cefaclor (P = 0.017). Haemophilus influenzae was eliminated in 13 of 14 (93%) patients given TMP-SMZ compared with 10 of 18 (56%) given cefaclor (P = 0.047). Clinical outcomes failed to distinguish between patients given TMP-SMZ or cefaclor. Symptoms improved despite persistent infection in 11 of 13 (85%) patients; middle-ear effusion persisted after therapy in 38 of 61 (62%) patients despite eradication of pathogens. We conclude that twice daily TMP-SMZ is more efficacious than twice daily cefaclor for the treatment of acute otitis media and that clinical outcomes may fail to detect differences between antibacterial agents in comparative drug trials in acute otitis media.

Topics: Acute Disease; Cefaclor; Cephalexin; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Female; Humans; Infant; Male; Otitis Media; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Pentamidine isethionate and sulfamethoxazole-trimethoprim are effective in the treatment of Pneumocystis carinii pneumonia in the immunosuppressed pediatric patient. To compare their efficacy and toxicity, 25 pediatric cancer patients with biopsy-proved P carinii pneumonia were randomly assigned to receive either pentamidine intramuscularly or sulfamethoxazole-trimethoprim orally for 14 days. No differences in response or frequency of side effects were noted between the two drug regimens, with recovery occurring in 24 (96%) of 25 children. Skin eruptions and hematologic abnormalities were the most common side effects of sulfamethoxazole-trimethoprim therapy, while local reactions at injection sites, abnormal renal function, and hypoglycemia were the most frequent complications of pentamidine treatment. The ease of administration and less serious side effects of sulfamethoxazole-trimethoprim make it the drug of first choice for treating P carinii pneumonia. Pentamidine remains an important drug for patients who fail to respond to this initial therapy.

Topics: Acute Disease; Adolescent; Adult; Amidines; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Humans; Infant; Infant, Newborn; Leukemia; Male; Pentamidine; Pneumonia, Pneumocystis; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of a single-dose (4 tablets) trimethoprim-sulfamethoxazole (TMP-SMX) was compared with that of a 3-day and 10-day treatment with TMP-SMX, 2 tablets twice daily, in 464 female out-patients with symptoms denoting acute, uncomplicated urinary tract infection (UTI). 321 patients (70%) had significant bacteriuria. Treatment effect could be assessed in 279 women. Comparable results were obtained with the 3 regimens 2 and 6 weeks after treatment. Eradication of the initial organism occurred in 96% with single-dose, in 96-94% with a 3-day, and in 98% with a 10-day course. The incidence of adverse reactions was significantly greater in patients treated with a 10-day (28%) than in those treated with a single-dose (5%), or 3-day (9%) regimen (p less than 0.01). This study suggests that short treatment regimens for uncomplicated UTI in women are as effective as and cause fewer side-effects than the conventional 10-day chemotherapy.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Middle Aged; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of single-dose therapy with trimethoprim-sulfamethoxazole (TMP-SMZ) and the cost-effectiveness of routine urinalyses and cultures were studied in a prospective randomized trial of 200 women who presented with symptoms of acute lower urinary tract infection. Without the physician's knowledge of the results of urinalysis or culture, the patients were randomly assigned to receive either a single dose or a 10-day multiple-dose course of TMP-SMZ and were followed up for 6 months. Of the 136 patients with positive urine cultures, 68 received single-dose therapy with TMP-SMZ--10 of whom had relapses--and 68 received multiple-dose therapy with TMP-SMZ--only 2 of whom had relapses (P less than 0.02). Fifteen patients in each treatment group experienced reinfection. Side effects of rash and vaginitis were more common in patients who received multiple-dose therapy, but they were mild and well tolerated. Of the 51 patients with urethral syndrome, 48 became asymptomatic after therapy. None of the following tests predicted treatment outcome: pretreatment urinalysis, urine culture or susceptibility testing, antibody-coated bacteria testing, or routine follow-up urinalyses or urine cultures. Empiric therapy with TMP-SMZ in selected women with symptoms of acute uncomplicated urinary tract infection seems practical, safe, and cost-efficient. Considerable savings can be achieved by reserving urinalyses and urine cultures for patients with persistent or recurrent symptoms. Higher cure rates can be expected in patients who receive a standard 10-day course of therapy with TMP-SMZ compared with those who receive single-dose therapy with TMP-SMZ.

Topics: Acute Disease; Adolescent; Adult; Clinical Trials as Topic; Cost-Benefit Analysis; Cystitis; Drug Combinations; Female; Humans; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

The efficacy of orally administered trimethoprim/sulfamethoxazole for infection prevention following induction chemotherapy was evaluated in 43 patients with acute leukemia. Twenty patients were randomly assigned to treatment with trimethoprim/sulfamethoxazole during 20 episodes of profound granulocytopenia; 23 patients in the control group were followed through 25 granulocytopenic episodes. The incidences of superficial skin and overall infections were significantly lower in those patients with multiple relapses who received trimethoprim/sulfamethoxazole (p = 0.008); however, there was no difference between the groups in regard to days of fever, days of antibiotic administration, days of hospitalization, or gram-negative rod bacteremia. As a result of this study, this regimen cannot be unequivocally recommended for infection prevention in neutropenic patients with acute leukemia undergoing induction or reinduction chemotherapy.

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Antineoplastic Agents; Drug Combinations; Drug Evaluation; Female; Humans; Infection Control; Leukemia; Leukocyte Count; Male; Middle Aged; Neutropenia; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Sixty-seven previously healthy patients with acute bronchitis were randomized and treated with either a fixed dose of trimethoprim and sulfamethoxazole or placebo for seven days. All outcomes examined showed a trend favoring the use of antibiotic, with statistically significant differences for cough, night cough, mean temperature, and use of antihistamines or decongestants. Night cough occurred on 84 percent of nights in the control group vs 56 percent in the antibiotic group (P = .003). Cough occurred on 99 percent of days for patients in the control group vs 93 percent of days for patients in the antibiotic group (P = .05). Mean temperature over the seven nights was 37.3 degrees C in the control group vs 36.9 degrees C in the antibiotic group (P = .004). The use of antihistamines and decongestants was reduced from 32 percent of days in the control group to 6 percent of days in the antibiotic group (P = .005). Patients in the antibiotic group worked 73 percent of days vs 55 percent of days for patients in the control group, which was significant when patients were stratified by the appearance of their sputum on Gram stain (P = .006). Smoking history was not found to help predict the response to antibiotic therapy.

Topics: Acute Disease; Adolescent; Adult; Bronchitis; Cough; Double-Blind Method; Drug Combinations; Drug Evaluation; Humans; Random Allocation; Sputum; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A new antimicrobial drug combination of trimethoprim and methenamine hippurate (TMP + MH) at 2 different dosages (100 + 500 mg and 200 + 1000 mg b.i.d.) was compared by a random double-blind technique with plain TMP (200 mg b.i.d.) and TMP-sulfamethoxazole combination (160 mg + 800 mg b.i.d.). Each of the 4 test groups of 40-47 patients with acute UTI was treated for 2 weeks. The successful response in the test groups varied from 91 to 98% and no statistical difference could be found between the groups. The side-effects were least common in the group treated with the lower dose of TMP-MH combination.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Double-Blind Method; Drug Combinations; Female; Hippurates; Humans; Male; Methenamine; Middle Aged; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Child; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

43 patients undergoing treatment for acute leukaemia were randomised to receive either co-trimoxazole alone or co-trimoxazole with framycetin and colistin as antibacterial prophylaxis during periods of neutropenia. There were no significant differences between the two treatment groups in the time before the onset of the first fever, the number of episodes of fever or of septicaemia per patient, the number of neutropenic days during which patients remained afebrile or did not require systemic antibiotics, or the number of resistant organisms acquired. Co-trimoxazole alone is cheaper and easier to take than co-trimoxazole with framycetin and colistin, and it is therefore preferable to the three-drug combination for the prophylaxis of bacterial infection.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Female; Framycetin; Humans; Leukemia; Male; Middle Aged; Neutropenia; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Bacterial Agents; Bone Marrow Transplantation; Clinical Trials as Topic; Colistin; Drug Combinations; Humans; Infection Control; Leukemia, Myeloid; Mycoses; Neomycin; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents; Camphanes; Child; Child, Preschool; Drug Combinations; England; Family Practice; Female; Humans; Infant; Male; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Double-Blind Method; Drug Combinations; Female; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Patient compliance and drug efficacy and side-effects were compared in two groups of patients with symptoms of acute lower urinary tract infections. One group was treated with trimethoprim, one tablet (300 mg) once a day, and the other with co-trimoxazole, two tablets (160 mg trimethoprim, 800 mg sulphamethoxazole) twice a day; both treatments were prescribed for seven days. Patient compliance was significantly greater with trimethoprim: corrected percentage compliance rates were 97.5 per cent for trimethoprim and 79.1 per cent for co-trimoxazole (p<0.05). Trimethoprim and co-trimoxazole were of equivalent effectiveness in the control of symptoms. Side-effects were more frequent with co-trimoxazole, but the difference was not significant.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacterial Infections; Drug Combinations; Female; Humans; Middle Aged; Patient Compliance; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adolescent; Adult; Aged; Ampicillin; Anti-Bacterial Agents; Bronchial Diseases; Clinical Trials as Topic; Doxycycline; Drug Combinations; Female; Humans; Male; Middle Aged; Oxytetracycline; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Human brucellosis can be managed with different therapeutic measures. The present study compares the therapeutic efficacy of the classical treatment with streptomycin, doxicyclin and cotrimoxazole, every one of the treatment regimes being applied to 19 patients with acute brucellosis. The results do not demonstrate an advantage of the new association over the classical treatment. Relapses, time elapsed until the patient was afebrile and drug tolerance were similar for both treatments. The classical treatment has a lower cost but the new association implies more patient comfort because the number of pills to be ingested daily is reduced to less than half, a fact that could make it the treatment of choice.

Topics: Acute Disease; Adolescent; Adult; Brucellosis; Child; Clinical Trials as Topic; Doxycycline; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Streptomycin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Female; Fluid Therapy; Fluoroquinolones; Humans; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis

The acute-subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute-subacute PCM, to determine a mortality risk factor and to propose a test for non-survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute-subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole-trimethoprim (SMX-TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut-off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute-subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

Topics: Acute Disease; Adolescent; Brazil; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Paracoccidioides; Paracoccidioidomycosis; Qualitative Research; Retrospective Studies; Risk Factors; Serum Albumin; Trimethoprim, Sulfamethoxazole Drug Combination

Diarrhoea and urinary tract infection (UTI) are common clinical problems. Meanwhile, Escherichia coli (E. coli), is the commonest bacterial pathogen reported in both of them. This study aimed to evaluate the pathogenic E. coli (PEC) in stool of acute diarrhoea and urine of UTI regarding their virulence genes and their influence on the susceptibility to routinely prescribed antibiotics.. Twenty two stool and another 22 urine samples of patients with acute diarrhoea and UTI respectively were collected from patients admitted at Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Egypt. E. coli isolation, identification of their phyla; chuA, yjaA, and TspE4.C2, and further identification of 10 virulent genes; fimH, papC, papG//, papG///, papEF, afa, sfa, CNF1, iroN & hlyA was performed. Antibiotic susceptibility was studied against quinolones, gentamicin (GM), and trimethoprim-sulphamethoxazole (TMP-SMX).. The studied virulence genes were comparably detected in both pathogenic samples. In diarrheogenic E. coli (DEC); phylum A was significantly related to both ciprofloxacin (CIP) and TMP-SMX resistance, and both of the virulence genes fimH and iroN were significantly related to all the studied antibiotics resistance, while afa was significantly related to nalidixic acid (NA) resistance. In uropathogenic E. coli (UEC); phylum D was significantly related to CIP and levofloxacin resistance, and both of the virulence genes fimH and iroN were significantly related to most of the studied antibiotics resistance.. The isolated PEC was evidently and broadly resistant to the studied antibiotics, with limited influence of their phyla and virulence genes (fimH and iroN).

Topics: Acute Disease; Anti-Bacterial Agents; Diarrhea; Egypt; Escherichia coli; Escherichia coli Proteins; Feces; Gentamicins; Humans; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

Pulmonary toxicity induced by trimethoprim-sulfamethoxazole (TMP-SMX) has been described, although the disease process is poorly understood. We report 5 previously healthy adolescent patients who developed acute respiratory failure while taking TMP-SMX. Four of the 5 adolescents required extracorporeal membrane oxygenation support, and 2 of the teenagers died. All children required a tracheostomy, and all cases were complicated by pneumothoraces and pneumomediastinum. The majority of children were prescribed TMP-SMX for the treatment of acne vulgaris.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Female; Humans; Male; Respiratory Insufficiency; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination

Salmonella and Shigella remain the major contributors to acute enteric infections and diarrhoea. Hence, the objective of this study was to isolate and determine the antimicrobial susceptibility pattern of Shigella and Salmonella species from children with acute diarrhoea in Mekelle Hospital and Semen Health Center.. A cross sectional study was conducted among 260 children with acute diarrhoea from November 2011 to March 2012 in Mekelle, Ethiopia. Stool specimen was collected from all study participants who presented with acute diarrhoea. Microscopy, culture and confirmatory identification were done by the pattern of biochemical reactions using a standard bacterial identification system (API 20E, BioMerieux, Marcy-l'Etoile, France) and polyvalent (Poly O and H) antiseras for Salmonella species and Vi for S.typhi. Isolated colonies were assessed for antimicrobial susceptibility profile using disk diffusion method. Data was entered and analyzed using SPSS version 16.0 software.. Out of the 260 study participants, 145(55.8%) were males while 115(44.2%) were females. The majority of the patients (44.2%) were of children under five years old. A total of 120 enteropathogens were isolated. The frequency of isolation was 19(7.3%), 18(6.9%) and 83(31.9%) for Salmonella species, Shigella species and intestinal parasites respectively. Most of the Shigella isolates were resistant to ampicillin (88.9%), Tetracycline (77.8), cotrimoxazole (55.6%) and chloramphenicol (55.6%). Among the Salmonella isolates, the highest resistance was observed to ampicillin (89.5%), Tetracycline (89.5%), chloramphenicol (78.9%) and cotrimoxazole (57.9%). Multi-drug resistance was noted in 19(100%) and 16(88.9%) of Salmonella and Shigella species respectively.. Shigella and Salmonella are still challenging pathogens in children < 5 years of age. High antibiotic resistance was observed among both isolates to ampicillin, tetracycline, chloramphenicol and cotrimoxazole.

Topics: Acute Disease; Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Cross-Sectional Studies; Diarrhea; Dysentery, Bacillary; Ethiopia; Feces; Female; Hospitals; Humans; Infant; Male; Microbial Sensitivity Tests; Pediatrics; Salmonella; Salmonella Infections; Shigella; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Chronic Disease; Crystallization; Humans; Kidney Diseases; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

We hypothesized that cases of uncomplicated cystitis treated in a Urology Department would display higher antimicrobial susceptibility than those reported by the hospital antibiogram. This would suggest narrow spectrum antibiotics could still be an effective treatment for uncomplicated cystitis despite this era of antimicrobial resistance. The objective of this study was thus to evaluate the rates of antimicrobial susceptibility of isolates cultured from uncomplicated cystitis cases that presented to the Urology Department of a community hospital in Japan. We evaluated the efficacy of cefaclor, a narrow spectrum antibiotic, for uncomplicated cystitis. We further compared the rates of antimicrobial susceptibility of isolates from uncomplicated cystitis cases to those reported in a hospital-wide antibiogram. A retrospective chart review was performed of patients diagnosed with uncomplicated cystitis in the Urology Department. The patients were mainly treated orally by cefaclor at 750 mg/day for seven days. Significantly greater susceptibilities to cefazolin (87.0% vs 65.7%), trimethoprim-sulfamethoxazole (89.4% vs 79.1%) and levofloxacin (84.6% vs 66.9%) were observed in a cystitis antibiogram for Escherichia coli compared with a hospital-wide antibiogram. The clinical efficacy of cefaclor for acute cystitis was also demonstrated. The greater susceptibility of Escherichia coli to antimicrobials observed in this study supports the hypothesis that antimicrobial susceptibility rates in uncomplicated cystitis cases that present to the Urology Department would be greater than those reported in the hospital antibiogram. Therefore, uncomplicated acute cystitis can be treated by narrow spectrum antibiotics such as cefaclor even in this ''antimicrobial resistance era''.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Cystitis; Escherichia coli; Female; Hospitals, Community; Humans; Japan; Levofloxacin; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urology; Young Adult

Medicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city.. This was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection.. The prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68).. Children are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial agents accessed and used without a prescription in Kampala city, Uganda.

Topics: Acetaminophen; Acute Disease; Adult; Amoxicillin; Anti-Infective Agents; Artemether, Lumefantrine Drug Combination; Artemisinins; Child; Child, Preschool; Cough; Cross-Sectional Studies; Drug Combinations; Ethanolamines; Family Characteristics; Female; Fever; Fluorenes; Humans; Infant; Male; Nonprescription Drugs; Respiratory Tract Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda; Young Adult

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study sought to compare the antimicrobial susceptibility rates between acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who were considered unresolved cases, and newly presenting acute uncomplicated cystitis patients without recent antimicrobial use within 3 months and to determine whether different treatment strategies should be applied according to recent antimicrobial exposure (RAE). Female acute uncomplicated cystitis patients with Escherichia coli growth, who visited our hospital's urology department from 2010 to 2014, were divided according to RAE. The antimicrobial susceptibility of E. coli was compared between the group with RAE and the group with no antimicrobial exposure (NAE) within 3 months. The total number of acute uncomplicated cystitis patients with E. coli growth was 259: 40 patients comprised the RAE group and 219 patients formed the NAE group. The mean age was significantly older and previous recurrent cystitis history was higher in the RAE group (p < 0.05). Furthermore, the antimicrobial susceptibility of E. coli to amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, and trimethoprim-sulfamethoxazole was significantly lower in the RAE group, with susceptibility results of 64.7%/88.0% (RAE/NAE), 77.5%/89.0%, 79.4%/95.3%, 31.3%/64.2%, and 42.5%/70.6%, respectively. RAE was an independent factor for antimicrobial resistance. This study showed that antimicrobial susceptibilities were significantly lower in acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who are defined as unresolved cases. Our results suggest that first-line antimicrobials might show poor efficacy in cases of unresolved, acute uncomplicated cystitis and alternative or secondary antimicrobials should be considered in these cases.

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Ciprofloxacin; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Recurrence; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Aged, 80 and over; Anti-Bacterial Agents; Antifungal Agents; Burkholderia cepacia; Candida glabrata; Fluconazole; Humans; Lung; Male; Pneumonia; Radiography, Thoracic; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis jirovecii pneumonia (PCP) is potentially fatal infectious complication in patients with rheumatoid arthritis (RA) during immunosuppressive therapy. Hospital survival due to human immunodeficiency virus-unrelated PCP reaches to 60%. The high mortality rate results from difficulties in establishing an early diagnosis, concurrent use of prophylactic drugs, possible bacterial coinfection. We herein report a case of PCP in RA patients who developed the architectural distortions of lung in spite of combined modality therapy.. A 73-year-old Japanese woman with RA was admitted with shortness of breath. Five weeks previously, she had been started on etanercept in addition to methotrexate (MTX). Chest computed tomography (CT) demonstrated diffuse ground glass opacities distributed throughout the bilateral middle to lower lung fields, and serum β-D-glucan was elevated. Bronchoalveolar lavage fluid revealed no P. jirovecii, but the organism was detected by polymerase chain reaction method. Trimethoprim/sulfamethoxazole was administered with methylprednisolone pulse therapy. However, the follow-up chest X-ray and chest CT demonstrated aggravation of the pneumonia with architectural distortions. Additional direct hemoperfusion with polymyxin B-immobilized fibers and intravenous cyclophosphamide therapy were insufficiently effective, and the patient died on day 25.. The architectural distortions of lung should be considered as a cause of death of PCP. For this reason, a high suspicion of this infectious complication must be kept in mind in order to establish an early diagnosis and treatment in patients with RA managed with MTX and biologics.

Topics: Acute Disease; Aged; Anti-Infective Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Disease Progression; Etanercept; Fatal Outcome; Female; Humans; Lung Diseases, Interstitial; Methotrexate; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymyxin B; Trimethoprim, Sulfamethoxazole Drug Combination

We report a unique case of acute bacterial prostatitis probably caused by Listeria monocytogenes in an HIV-infected patient. For the best of our knowledge, this is the first case reported of a patient with this association. Our case illustrates the protean clinical presentations that L. monocytogenes infections may adopt, particularly in immunocompromised patients.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; HIV Infections; Humans; Listeria monocytogenes; Listeriosis; Male; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Acute Disease; Anti-Bacterial Agents; Clindamycin; Dental Care; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Iris Diseases; Middle Aged; Streptococcal Infections; Streptococcus intermedius; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Prospective studies from developing countries that have investigated risk factors for trimethoprim-sulfamethoxazole (TMP-SMX)-resistant Escherichia coli in women with uncomplicated urinary tract infection (UTI) remain scarce.. Women with acute uncomplicated UTI were enrolled prospectively. Urine was sent for antimicrobial susceptibility testing. Logistic regression analysis was used to identify risk factors for TMP-SMX resistance.. Of 405 participants, 229 (56.5%) had bacteriuria (mean age 31.9 ± 9.5 years). In the previous 12 months, 77 (33.6%) had experienced at least one UTI episode and 106 (46.3%) reported antimicrobial use. The most common uropathogens were E. coli (75.8%) and Staphylococcus saprophyticus (8.9%). For the 179 E. coli, resistance rates were highest for ampicillin (64.3%) and TMP-SMX (41.3%). Resistance to cephalosporins, nitrofurantoin, and fluoroquinolones was much lower compared with the hospital laboratory-based surveillance data. Risk factors for TMP-SMX resistance were UTI in the last 6 months (odds ratio 2.22; p = 0.04) and the number of UTI episodes in the past year (odds ratio 2.06; p = 0.004). The number of UTI episodes (adjusted odds ratio 2.21; p = 0.02) remained significant on multivariate analysis.. TMP-SMX resistance was high. Number of previous UTI episodes was associated with increased risk of resistance; prior antimicrobial use was not. Hospital antibiograms should be used with caution when treating uncomplicated UTI.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Developing Countries; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus saprophyticus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

This article advocates the need for early incision and drainage of periorbital abscesses. We report a case of a 1.5-month-old neonate with orbital cellulitis and periorbital abscess, which had rapidly developed over a period of 3 days. Treatment history revealed methicillin-resistant Staphylococcus aureus sepsis treated with intravenous vancomycin, and incision and drainage of abscesses at multiple sites (left parotid region, upper and lower limbs). A small swelling noted on the left temporal region on discharge from the hospital was treated with oral cotrimoxazole. However, it spread rapidly to involve the periorbital tissue and the bones of the orbital walls to form a periorbital abscess and orbital cellulitis.

Topics: Abscess; Acute Disease; Drainage; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Orbit; Orbital Cellulitis; Sepsis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

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

We present a case of late acute myopia syndrome following discontinuation of treatment with a combination of sulphonamide drugs. To the best of our knowledge, this is the first reported case with such a presentation, and suggests that the pathophysiological basis for the acute myopia syndrome is a rapid decrease in serum carbonic anhydrase inhibitors levels which may lead to a rebound increase in the production of aqueous humor and accumulation of suprachoroidal fluid. It is further postulated that there may be a cumulative effect of sulphonamide drug use on carbonic anhydrase activity in the ciliary body epithelium of susceptible individuals.

Topics: Acute Disease; Adult; Anti-Infective Agents; Anticonvulsants; Drug Therapy, Combination; Female; Fructose; Humans; Intraocular Pressure; Migraine Disorders; Myopia; Pharyngitis; Topiramate; Trimethoprim, Sulfamethoxazole Drug Combination

In this study, mechanisms of plasmid-mediated sulfamethoxazole resistances in the clinical strains of multi-drug resistant (MDR) Shigella flexneri 2a were elucidated for the first time in Bangladesh. From 2006 to 2011, a total of 200 S. flexneri 2a strains were randomly selected from the stock of the Enteric and Food Microbiology Laboratory of icddr,b. Antimicrobial susceptibility of the strains showed 73%, 98%, 93%, 58%, 98%, 64% and 4% resistance to trimethoprim-sulfamethoxazole, nalidixic acid, ampicillin, erythromycin, tetracycline, ciprofloxacin and ceftriaxone respectively. Plasmid profiling revealed heterogeneous patterns and interestingly, all the trimethoprim-sulfamethoxazole resistant (SXT(R)) strains yielded a distinct 4.3 MDa plasmid compared to that of the trimethoprim-sulfamethoxazole susceptible (SXT(S)) strains. Curing of this 4.3 MDa plasmid resulted in the susceptibility to sulfamethoxazole alone suggesting the involvement of this plasmid in the resistance of sulfamethoxazole. Moreover, PCR analysis showed the presence of sul2 gene in SXT(R) strains which is absent in SXT(S) strains as well as in the 4.3 MDa plasmid-cured derivatives, confirming the involvement of sul2 in the resistance of sulfamethoxazole. Furthermore, pulsed-field gel electrophoresis (PFGE) analysis revealed that both the SXT(R) and SXT(S) strains were clonal. This study will significantly contributes to the knowledge on acquired drug resistance of the mostly prevalent S. flexneri 2a and further warrants continuous monitoring of the prevalence and correlation of this resistance determinants amongst the clinical isolates of Shigella and other enteric pathogens around the world to provide effective clinical management of the disease.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; Bangladesh; Carrier Proteins; Diarrhea; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Gene Expression; Humans; Plasmids; Shigella flexneri; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Amikacin; Anti-Bacterial Agents; Diarrhea; Female; Fluid Therapy; Hospitalization; Humans; India; Infant; Male; Probiotics; Trimethoprim, Sulfamethoxazole Drug Combination; Zinc Acetate

Some infectious organisms may give rise to acute pancreatitis; brucellosis, however, extremely rarely leads to acute pancreatitis. A 40-year-old man was diagnosed with acute pancreatitis, the etiology of which was determined to be acute brucellosis. The patient was discharged without complications approximately 15 days after the initiation of trimethoprim-sulfamethoxazole and doxycycline treatment. Brucella infections may rarely be complicated by acute pancreatitis. Thus, brucellosis should be remembered in the etiology of acute pancreatitis in regions such as Turkey, where Brucella infections are endemic.

Topics: Acute Disease; Adult; Agriculture; Brucellosis; Diagnosis, Differential; Doxycycline; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Diarrhoeal disease is still considered a major cause of morbidity and mortality among children. Among diarrhoeagenic agents, Shigella should be highlighted due to its prevalence and the severity of the associated disease. Here, we assessed Shigella prevalence, drug susceptibility and virulence factors. Faeces from 157 children with diarrhoea who sought treatment at the Children's Hospital João Paulo II, a reference children´s hospital in Belo Horizonte, state of Minas Gerais, Brazil, were cultured and drug susceptibility of the Shigella isolates was determined by the disk diffusion technique. Shigella virulence markers were identified by polymerase chain reaction. The bacterium was recovered from 10.8% of the children (88.2% Shigella sonnei). The ipaH, iuc, sen and ial genes were detected in strains isolated from all shigellosis patients; set1A was only detected in Shigella flexneri. Additionally, patients were infected by Shigella strains of different ial, sat, sen and set1A genotypes. Compared to previous studies, we observed a marked shift in the distribution of species from S. flexneri to S. sonnei and high rates of trimethoprim/sulfamethoxazole resistance.

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; Brazil; Child, Preschool; Diarrhea; Disk Diffusion Antimicrobial Tests; Dysentery, Bacillary; Feces; Female; Genotype; Humans; Infant; Male; Polymerase Chain Reaction; Prevalence; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence Factors

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Anti-Infective Agents; CD4 Lymphocyte Count; Combined Modality Therapy; Dacryocystitis; Dacryocystorhinostomy; Eye Infections, Fungal; Fatal Outcome; Female; Fluorescent Antibody Technique, Direct; HIV-1; Humans; Lacrimal Apparatus; Paracoccidioides; Paracoccidioidomycosis; Radiography; RNA; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load; Young Adult

Nocardia concava was identified as a new species in 2005; however, the clinical manifestations of Nocardia concava infection have yet to be clarified. We herein present the case of an immunosuppressed patient who developed disseminated nocardiosis caused by N. concava with multiple abscesses in the lungs, cutis, subcutaneous tissue, skeletal muscles and kidneys accompanied by central nervous system involvement, including meningitis and ventriculitis. The patient was cured with appropriate treatment including linezolid after testing for susceptibility. Linezolid should be considered as an alternative agent for treating disseminated nocardiosis because of its effective distribution to multiple sites.

Topics: Acetamides; Acute Disease; Aged; Anti-Bacterial Agents; Central Nervous System Diseases; Humans; Immunocompromised Host; Linezolid; Male; Microbial Sensitivity Tests; Minocycline; Nocardia; Nocardia Infections; Oxazolidinones; Respiratory Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Acetamides; Acute Disease; Adult; Anti-Bacterial Agents; Bacterial Toxins; Cellulitis; Drainage; Drug Therapy, Combination; Exotoxins; Fever; Humans; Iraq; Leg; Leukocidins; Linezolid; Magnetic Resonance Imaging; Male; Meropenem; Military Personnel; Oxazolidinones; Staphylococcal Infections; Staphylococcus aureus; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary tract infections (UTIs), the most common form of bacterial infection in kidney transplant recipients, recently have been demonstrated to be detrimental for long-term graft outcome. Therefore, reinforcing antibiotic prophylaxis might be vital, in addition to basic hygiene recommendations, surgical care, and prophylaxis by trimethoprim-sulfamethoxazole.. In 2006, a Legionella pneumophila contamination of our department's water pipes meant that all the patients undergoing renal transplantation underwent a 1-month regimen of ofloxacin (OFLO) (200 mg every other day). We took this opportunity to measure the incidence of UTI, including acute pyelonephritis (APN), in 100 consecutive patients transplanted before (n = 50) and after (n = 50) this treatment decision was reached. We also studied the antimicrobial resistance profiles in our department and in the rest of the hospital.. No patient developed Legionnaire's disease. A dramatic decrease in the incidence of UTI (-63%) was also seen in patients undergoing OFLO treatment. Logistic regression analysis demonstrated that the use of OFLO was independently associated with a reduction in UTI (odd ratio [OR] = 0.31%, 95% confidence interval [CI] 0.11-0.84, P = 0.02) and APN (OR = 0.21%, 95% CI 0.07-0.98, P = 0.045). This protection was sustained during the whole first year post transplantation. As for resistance rates, we observed a decrease in the susceptibility of Pseudomonas aeruginosa to ciprofloxacin in our nephrology department, compared with that observed in the rest of the hospital. The incidence of multi-resistant bacteria was stable.. Our unintentional extension of prophylactic antibiotherapy with OFLO gave rise to a dramatic decrease in the 1-year incidence of UTI and APN in kidney recipients. Emergence of resistant strains is, however, a major concern.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fluoroquinolones; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Incidence; Kidney Transplantation; Legionella pneumophila; Legionnaires' Disease; Male; Middle Aged; Ofloxacin; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the conventional management of osteomyelitis. While oral clindamycin is commonly used to treat acute CA-MRSA osteomyelitis, the emergence of inducible clindamycin resistance among CA-MRSA isolates has made alternative therapy necessary. The excellent oral bioavailability, susceptibility profile, favorable palatability, and low cost of trimethoprim-sulfamethoxazole (TMP-SMX) make this drug an attractive option for treating osteomyelitis, yet its clinical efficacy for osteomyelitis has not been established.. Between October 1998 and September 2009, 20 children who received a TMP-SMX-containing regimen for acute osteomyelitis at All Children's Hospital were identified from hospital records, and their cases reviewed for clinical outcome and drug safety.. Patients ranged in age from 9 months to 17 years. Twelve (60%) of the patients were male. Causative pathogens were found in 8 (40%) cases of which 5 were CA-MRSA and 3 were methicillin-susceptible Staphylococcus aureus. Eleven patients (55%) received TMP-SMX as their primary therapy. The median dose of TMP-SMX was 16.4 mg/kg/d. During TMP-SMX therapy, 8 patients (40%) experienced adverse events; all were considered mild. Duration of total therapy was 26 to 59 days, with a median of 40 days. All 20 patients were considered cured of their infection at the end of therapy.. Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.

Topics: Acute Disease; Administration, Oral; Adolescent; Anti-Infective Agents; Child; Child, Preschool; Female; Hospitals, Pediatric; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We investigated the risk factors for resistance to ciprofloxacin, cefazolin, ampicillin and co-trimoxazole in Escherichia coli isolates from urine of Korean female patients with acute uncomplicated cystitis (AUC). A total of 225 patients and their E. coli isolates were prospectively and nationwidely enrolled between May and October, 2006. All the antimicrobials did not show any differences according to the age group. A higher rate of ciprofloxacin resistance was observed in the south (OR: 3.04, 95% CI: 1.19-7.80 for Chungcheong-do & Jeolla-do; OR: 3.04, 95% CI: 1.22-7.58 for Gyeongsang-do) compared to Gyeonggi-do. Two recurrences of AUC in the past year was an important risk factor for antimicrobial resistance (ciprofloxacin; OR: 6.71, 95% CI: 1.86-24.11 and cefazolin; OR: 5.72, 95% CI: 1.20-27.25). However, the resistance to co-trimoxazole and ampicillin was not associated with any of the risk factors. This study also revealed the pattern of multi-drugs resistance in ciprofloxacin resistant E. coli strains. In conclusion, for Korean patients with two more recurrences of AUC in the past year, it is strongly recommended to perform an antimicrobial sensitivity test with a urine sample before empirical treatment.

Topics: Acute Disease; Adolescent; Adult; Aged; Ampicillin; Anti-Bacterial Agents; Cefazolin; Ciprofloxacin; Cystitis; Drug Resistance, Bacterial; Escherichia coli; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Republic of Korea; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Chronic neurotoxicity is a recognized long-term complication following chemotherapy in a range of diseases. Neurotoxicity adversely affects patients' quality of life. The objective of this study is to examine whether there is evidence of acute neurotoxicity.. This prospective study included patients with secondary progressive multiple sclerosis (SPMS-BMT, n = 14) and hematological malignancies (HM-BMT, n = 17) receiving chemotherapy as preconditioning for bone marrow transplant. The control groups included SPMS patients matched for demographic and clinical data (SPMS-PL, n = 14) and healthy controls (n = 14). Neurodegeneration was assessed at baseline and longitudinally (months 1, 2, 3, 6, 9, 12, 24, and 36), combining a clinical scale for disability (Expanded Disability Status Scale [EDSS]), a serum protein biomarker for neurodegeneration (neurofilaments, NfH-SMI35), and brain atrophy measures (magnetic resonance imaging).. Disability progression was significantly more acute and severe following chemotherapy compared to placebo. Immediately after starting chemotherapy, serum NfH-SMI35 levels increased in 79% (p < 0.0001) of SPMS-BMT patients and 41% (p < 0.01) of HM-BMT patients compared to 0% of SPMS-PL patients or healthy controls. In SPMS-BMT serum NfH-SMI35 levels were > 100-fold higher 1 month after chemotherapy (29.73ng/ml) compared to baseline (0.28ng/ml, p < 0.0001). High serum NfH-SMI35 levels persisting for at least 3 months were associated with sustained disability progression on the EDSS (p < 0.05). Brain atrophy rates increased acutely in SPMS-BMT (-2.09) compared to SPMS-PL (-1.18, p < 0.05).. Neurotoxicity is an unwanted acute side effect of aggressive chemotherapy.

Topics: Acute Disease; Adult; Anti-Infective Agents; Bone Marrow Transplantation; Brain; Case-Control Studies; Disability Evaluation; Drug-Related Side Effects and Adverse Reactions; Female; Hematologic Neoplasms; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Sclerosis, Chronic Progressive; Neurofilament Proteins; Neurotoxicity Syndromes; Prednisolone; Single-Blind Method; Statistics, Nonparametric; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis, Chronic; Diagnosis, Differential; Drug Therapy, Combination; Fluoroquinolones; Glucocorticoids; Humans; Practice Guidelines as Topic; Prednisone; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The epidemiology of acute pyelonephritis (APN) has changed with time. Therefore we investigated the current clinical characteristics of APN and the significance of proper surgical management for treatment of 1,026 APN patients in South Korea for the past 5 yr. The male-to-female ratio was about 1:8. The peak ages of female patients were 20s (21.3%) and over 60s (23.7%), while that of male was over 60s (38.1%). The occurrence of sepsis was 10.1%. Complicated APN patients were 35.4%. Ninety-four patients (9.2%) needed urological procedures. The duration of the flank pain and of the costovertebral angle tenderness in complicated APN patients was statistically significantly longer than that with simple APN patients (4.3 vs. 3.4 days, 4.4 vs. 4.0 days). If flank pain and costovertebral angle tenderness sustain over 4 days, proper radiologic studies should be performed immediately with the consideration of surgical procedure. Also the resistance to antibiotics was increasing. As the sensitivities to ampicillin (27.2%) and trimethoprim/sulfamethoxazole (44.7%) of Escherichia coli and Klebsiella pneumoniae were very low, it is necessary to take the careful choice of antibiotics into consideration.

Topics: Acute Disease; Adult; Aged; Ampicillin; Drug Resistance; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Retrospective Studies; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination

Acute interstitial nephritis (AIN) secondary to trimethoprim-sulfamethoxazole (TMP-SMX) is well documented as a cause of acute renal failure in native kidneys. TMP-SMX is the standard prophylactic agent against pneumocystis carinii (PCP) used in the early post-transplant period, however, it has to date only been indirectly associated with AIN in renal allografts.. We describe eleven renal transplant patients with acute allograft dysfunction in whom a transplant biopsy demonstrated primary histopathologic features of allergic AIN, all of whom were receiving TMP-SMX in addition to other medications known to cause AIN.. All cases occurred within 1 month of transplantation and accounted for 2.12% (11/518) of the total number of transplant biopsies performed during the study period. However, this figure increased to 10.1% (11/109) when those biopsies performed for early allograft dysfunction (< 1 month) were taken into account. After discontinuation of TMP- SMX alone, all patients had an immediate improvement in serum creatinine with excellent long term allograft function - mean improvement of serum creatinine from 465 micromol/l to 136 micromol/l at last follow-up (range 15 - 55 months).. AIN secondary to TMP-SMX, although an uncommon cause of allograft dysfunction over the study period, accounted for over 10% of cases of allograft dysfunction within the first month of transplantation. Therefore, a high degree of clinical suspicion for TMP-SMX-induced AIN is warranted when confronted with early acute allograft dysfunction.

Topics: Acute Disease; Adult; Aged; Anti-Infective Agents; Creatinine; Female; Humans; Immunosuppressive Agents; Kidney; Kidney Transplantation; Male; Middle Aged; Nephritis, Interstitial; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of epididymo-orchitis and central nervous system nocardiosis in a 22-year-old man with T-cell acute lymphoblastic leukemia; he was an allogeneic marrow recipient with acute and chronic graft-versus-host disease.. He had microscopic hematuria and cytomegalovirus antigenemia. He deteriorated subsequently while on cyclosporine and steroids, requiring hospital admission owing to fever and swelling of the left testis and generalized tonic-clonic convulsions.. Brain magnetic resonance imaging showed abnormal signal area in right parietal and left parieto-occipital lobes. The lesions had mass effect, edema, and ring enhancement. Findings were indicative of a brain abscess. A testicular biopsy from the lower pole of the left testis was done. A white-to-yellowish discharge was seen and subsequently, Nocardia grew in culture.. Trimethoprim-sulfamethoxazole was prescribed, and significant improvement was seen after 2 weeks. The patient was discharged. He was subsequently referred after 3 weeks due to graft-versus-host disease and died of pancytopenia.

Topics: Acute Disease; Anti-Infective Agents; Bone Marrow Transplantation; Brain Abscess; Chronic Disease; Epididymitis; Epilepsy, Tonic-Clonic; Fatal Outcome; Graft vs Host Disease; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Nocardia Infections; Orchitis; Pancytopenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 22-year-old man was admitted to our hospital with fever, cough and dyspnea. His chest radiograph showed diffuse ground-glass attenuation in both lung fields. Arterial blood gas analysis showed hypoxemia (PaO2 28.7 Torr breathing room air) and he required mechanical ventilation within 6 hours after admission. Gomori methenamine silver (GMS) stain of the bronchoalveolar lavage (BAL) fluid smear showed round and indented organisms, and polymerase chain reaction revealed pneumocystis jirovecii in the BAL fluid. The HIV antibody was positive and peripheral blood CD4-positive lymphocytes decreased to 4.0%. Pneumocystis pneumonia complicated with acquired immunodeficiency syndrome (AIDS) was diagnosed. There was no four-fold rise in screen viral titers. We treated him with antibiotics, trimethoprim-sulfamethoxazole, ganciclovir, fos-fluconazole, steroid pulse therapy and sivelestat sodium hydrate. Respiratory failure was relieved within 5 days following treatment. The percentage of neutrophils in the BAL fluid was elevated (44.6%). Neutrophil elastase on admission was increased and improved to the normal range after treatment. Sivelestat sodium hydrate is an anti-neutrophil elastase inhibitor and may be one of the treatment options for acute respiratory failure due to pneumocystis pneumonia in AIDS patients.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Adult; Drug Therapy, Combination; Ganciclovir; Glycine; Humans; Male; Methylprednisolone; Pneumonia, Pneumocystis; Proteinase Inhibitory Proteins, Secretory; Pulse Therapy, Drug; Respiratory Insufficiency; Severity of Illness Index; Sulfonamides; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Over six months, 129 consecutive brucellosis cases were diagnosed in females attending the outpatients' clinics the females in Al-Azhar and Ain Shams Universities Hospitals. Their ages ranged between 12-65 years old. 113 (87.6%) gave history of raw milk consumption, 13 (10%) gave history of home slaughtering of sheep, 2 (1.5%) gave history of animal contact, and one patient gave history of abortion, that partner had brucellosis. A total of 61.2% of patients gave serum agglutination test of 1: 640, who suffered acute or subacute infection. Titers of 1:320 (38.8%) were found in the majority of chronic cases. Causes of endemic parasitosis were excluded. Symptoms were fever (79.5%), headache (72.4%), generalized arthralgia (65.3%), sweating (65.3%), chills (63.8%), backache (34.6%), abdominal pain (27.5%), loss of appetite (25.5%), lassitude (17.2%), myalgia (14.2%), monoarthralgia (7.9%). Spinal involvement was in 15% patients, who had chronic brucellosis. 32/35 were successfully treated with a combination of streptomycin and tetracycline, 17/21 with streptomycin and septrin, 38/43 with tetracycline and septrin, and 26/26 (100%) with rifampicin and tetracycline or septrin, which treated all resistant patients.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Brucellosis; Child; Chronic Disease; Drug Therapy, Combination; Egypt; Female; Fever; Humans; Middle Aged; Rifampin; Risk Factors; Streptomycin; Tetracycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Emerging antimicrobial resistance among uropathogens makes the management of acute uncomplicated cystitis increasingly challenging. Few prospective data are available on the risk factors for resistance to trimethoprim-sulfamethoxazole (TMP-SMX), the drug of choice in most settings. In order to evaluate this, we prospectively enrolled women 18 to 50 years of age presenting to an urban primary care practice with symptoms of cystitis. Potentially eligible women provided a urine sample for culture and completed a questionnaire regarding putative risk factors for TMP-SMX resistance. Escherichia coli isolates were tested for clonal group A (CGA) membership by a fumC-specific PCR. Of 165 women with cystitis symptoms, 103 had a positive urine culture and were eligible for participation. E. coli was the predominant uropathogen (86%). Fifteen (14.6%) women had a TMP-SMX-resistant (TMP-SMX r) organism (all of which were E. coli). Compared with the women who had a TMP-SMX-susceptible organism, women in the TMP-SMX r group were more likely to have traveled (odds ratio [OR], 15.4; 95% confidence interval [CI], 4.4 to 54.3; P < 0.001) and to be Asian (OR, 6.1; 95% CI, 1.0 to 36.4; P = 0.048). CGA was also independently associated with TMP-SMX resistance (OR, 105; 95% CI, 6.3 to 1,777.6; P = 0.001). No association with TMP-SMX resistance was demonstrated for the use of either TMP-SMX or another antibiotic in the past 3 months or with having a child in day care. Among these women with acute uncomplicated cystitis, Asian race and recent travel were independently associated with TMP-SMX resistance. TMP-SMX r isolates were more likely to belong to CGA. Knowledge of these risk factors for TMP-SMX resistance could facilitate the accurate selection of empirical therapy.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urine

Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9-10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.

Topics: Acute Disease; Administration, Oral; Cefazolin; Debridement; Discitis; Diskectomy; Epidural Abscess; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Paraplegia; Postoperative Care; Postoperative Complications; Recovery of Function; Spinal Cord Compression; Spinal Fusion; Staphylococcal Infections; Thoracic Vertebrae; 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

Uncomplicated urinary tract infection (UTI) is one of the most common infections encountered and treated in outpatients. A set of guidelines published in 1999 by the Infectious Diseases Society of America recommends trimethaprim-sulfamethoxazole as first-line therapy.. We undertook a study of cross-sectional data describing the use of ambulatory medical services in the United States by women > or = 18 years of age who had uncomplicated UTI. Data from 1996 to 2001 were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to (1) examine the prescribing practices for the treatment of uncomplicated UTI and (2) determine whether these practices were influenced by the recommendation in the Infectious Diseases Society of America guidelines. The major outcomes measurement was to evaluate whether antibacterial selection was influenced by the Infectious Diseases Society of America guidelines. Data were analyzed by year, treatment in private offices vs. hospital clinics, race, geographic location, the specialty of the prescribing health care provider, and the payment method of the patient.. We identified 2339 cases of uncomplicated UTI. Trimethaprim-sulfamethoxazole and ciprofloxacin were the most commonly prescribed drugs. Despite the Infectious Diseases Society of America guidelines, the use of trimethaprim-sulfamethoxazole did not change significantly (odds ratio, 0.89; 95% confidence interval, 0.60-1.30; P = .53), whereas the use of ciprofloxacin increased significantly (odds ratio, 1.75; 95% confidence interval, 1.11-2.75; P < or = .016). Similar results were obtained after adjusting for age, geographic region, race, physician specialty, payment method, and whether the visit was by a new or returning patient.. Despite the Infectious Diseases Society of America recommendation of trimethaprim-sulfamethoxazole as first-line therapy for uncomplicated UTI, physicians in the United States have not altered their prescribing practices. Adjustment for age, geographic region, race, physician specialty, and payment method confirmed a lack of adherence to this recommendation.

Topics: Acute Disease; Adult; Aged; Ambulatory Care; Anti-Infective Agents, Urinary; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Utilization; Female; Guideline Adherence; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Probability; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

To describe the different modalities of ambulatory management of acute pyelonephritis in patients older than 3 months of age in paediatric emergency units of the Ile de France region in 2004.. Between October 2003 and April 2004, referents of 39 paediatric emergency units of the Ile de France region were questioned through a written questionnaire concerning the management of acute pyelonephritis: in or outpatient modalities, antibiotic regimen (molecule and route of administration), investigations and follow-up.. Thirty-one questionnaires (79.5%) were returned and analysed. A written protocol was available in 60% of the units. Outpatient management was performed in 24/31 centres. Young age, poor clinical tolerance, urological abnormalities and social difficulties were the major contra-indications for such management. Ultrasonic echography at diagnosis (within 24 h) was performed in 50% of the units. Antibiotics were started using IV route in 18/24 units (75%) and ceftriaxone and aminoside were respectively prescribed in 100% and 29.4% of the units for a duration of 1 to 5 days before switching to the oral route. Antibiotherapy was started orally in 6 units and cefixime was chosen by 5 of them. Follow-up consultations were scheduled in 100% of the units but with various delay after initiation of the treatment. The total duration of treatment was mostly 10 days and oral prophylactic antibiotherapy was prescribed by 10/24 centres after completion of the treatment. Cystoureterography was systematically realized by 83.3% of the units.. Despite important differences in the management of acute pyelonephritis in Ile-de-France, a majority of the units follows similar therapeutic modalities. In the absence of consensus, new recommendations are necessary concerning the management of pyelonephritis in infants and children in France.

Topics: Acute Disease; Administration, Oral; Adolescent; Age Factors; Anti-Bacterial Agents; Cefaclor; Cefixime; Ceftriaxone; Child; Child, Preschool; Data Collection; Drug Therapy, Combination; Emergency Service, Hospital; Follow-Up Studies; France; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Intensive Care Units, Pediatric; Outpatients; Pyelonephritis; Surveys and Questionnaires; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Urethra; Urinary Bladder; Urography

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is a frequent coloniser of fluids used in the hospital setting. It causes infection in immunosuppressed hosts, especially those who are neutropaenic, on chemotherapy and broad spectrum antibiotics. Skin and soft tissue manifestations of Stenotrophomonas maltophilia infection are becoming an increasingly recognised entity; the clinical spectrum ranges from mucocutaneous, skin to soft tissue infections.. We present a case of an 8-year-old girl with acute myeloid leukaemia who developed metastatic skin lesions secondary to Stenotrophomonas maltophilia bacteraemia. The authors reviewed a total of 24 reported cases of mucocutaneous, skin and soft tissue infections by Stenotrophomonas maltophilia. The presentations include metastatic cellulitis, primary cellulitis and infected mucocutaneous ulcers.. This is the first locally reported case of metastatic nodular skin lesions caused by Stenotrophomonas maltophilia bacteraemia. This is also the first reported paediatric case of embolic skin lesions caused by Stenotrophomonas maltophilia. Of the 6 cases of Stenotrophomonas maltophilia bacteraemia seen in the paediatric oncology patients from year 2000 to 2004 at our hospital, only 1 case developed metastatic skin lesions.. Stenotrophomonas maltophilia skin infection should be included into the list of differential diagnoses for metastatic skin lesions in neutropaenic patients, especially with an underlying haematologic malignancy who has received recent chemotherapy and broad spectrum antibiotics. Haematologic malignancy, transplantation, neutropaenic, immunosuppressive therapy and a high severity of illness score were important prognostic factors.

Topics: Acute Disease; Anti-Infective Agents; Bacteremia; Cellulitis; Child; Comorbidity; Female; Gram-Negative Bacterial Infections; Humans; Leukemia, Myeloid; Neutropenia; Prognosis; Skin Diseases, Bacterial; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Escherichia coli; Escherichia coli Infections; Female; Food Microbiology; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Zoonoses

We describe a rare adverse reaction to trimethoprim-sulfamethoxazole (TMP-SMX; Septra, Bactrim) in an immune-competent female adolescent. She was prescribed TMP-SMX for a urinary tract infection, which she had developed while being treated in the hospital for an extensive leg cellulitis. Shortly after receiving her third dose of TMP-SMX, she developed an acute altered mental status with agitation as well as vivid visual and auditory hallucinations. After prompt discontinuation of TMP-SMX, the patient slowly began to improve and was able to return to her baseline mental status within 10 days. No residual mental status changes were present. Despite the recent emergence of multidrug-resistant bacterial pathogens, TMP-SMX, one of the first-generation broad-spectrum antibiotics, continues to be widely prescribed, in part because of its low cost and its easy availability. It is generally well tolerated and is associated with relatively few adverse effects. More common toxicities associated with TMP-SMX include hypersensitivity reactions, bone marrow suppression, and gastrointestinal side effects. Central nervous system toxicity is very rare; when reported, it has been in an immune-compromised or an elderly patient.

Topics: Acute Disease; Administration, Oral; Adult; Akathisia, Drug-Induced; Cellulitis; Female; Humans; Immunocompetence; Psychoses, Substance-Induced; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antimalarial drugs including the antifolate, pyrimethamine-sulfadoxine (PS), can modulate the prevalence and intensities of gametocytaemia following treatment of acute malaria infections. They may also directly influence the transmission and spread of drug insensitivity. Little is known of the effects of co-trimoxazole (Co-T), another antifolate antimalarial, on gametocytes in children with acute malaria infections. We compared the effects of Co-T and PS on the prevalence and intensities of gametocytaemia and gametocyte sex ratios in 102 children aged 0.5-12 years presenting with acute and uncomplicated falciparum malaria. Compared to pre-treatment, both drugs significantly increased gametocyte carriage post-initiation of treatment. However, gametocyte carriage was significantly lower on day 14 in those treated with Co-T than PS. Significant increase in gametocytaemia with time occurred in PS--but not Co-T-treated children. Kaplan-Meier survival curve of the cumulative probability of remaining gametocyte-free in children who were agametocytaemic at enrollment showed that by day 7 of follow up, children treated with PS had a significantly higher propensity to have developed gametocytes than in Co-T-treated children (Log-rank statistic 5.35, df = 1, P = 0.02). Gametocyte sex ratio changes were similar following treatment with both drugs. PS and Co-T treatment of acute malaria infections in children from this endemic area is associated with significant increases in prevalence and intensities of gametocytaemia but these effects are more marked in those treated with PS than Co-T.

Topics: Acute Disease; Animals; Antimalarials; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Female; Folic Acid Antagonists; Humans; Infant; Malaria, Falciparum; Male; Plasmodium falciparum; Pyrimethamine; Sex Ratio; Sulfadoxine; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

For many years, trimethoprim-sulfamethoxazole (TMP-SMX) has been recommended as an alternative antimicrobial agent for the treatment of children with otitis media (OM). This study analyzed the in vitro activity of TMP-SMX against respiratory pathogens obtained from middle ear fluid of Costa Rican children 6-60 months of age with acute OM, recurrent OM, therapeutic failures and acute OM at risk for having a resistant pathogen. Between 2002 and 2003, a total of 124 middle ear fluid bacterial isolates were analyzed and compared with historic data from 1992 to 1997. A significant increase in the number of TMP-SMX Streptococcus pneumoniae (P = 0.00008)- and Haemophilus influenzae (P = 0.04)-resistant strains was observed during 2002-2003 when compared with strains from 1992-1997.

Topics: Acute Disease; Anti-Bacterial Agents; Costa Rica; Drug Resistance, Microbial; Female; Haemophilus influenzae; Humans; Male; Microbial Sensitivity Tests; Otitis Media with Effusion; Risk Factors; Sampling Studies; Sensitivity and Specificity; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To report our experience in identification and treatment of acute otitis media (AOM) with otorrhea secondary to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which is seen in children at increasing rates.. Clinical and laboratory records were retrospectively reviewed between January 2003 and December 2003.. Primary pediatric clinic.. Six pediatric patients who had AOM with otorrhea caused by CA-MRSA.. Clinical resolution of AOM with otorrhea.. All patients had acute-onset otorrhea associated with their AOM. Five patients had tympanostomy tubes and 1 had perforation of the tympanic membrane. None of the patients were responding to treatment with oral antibiotics (amoxicillin sodium-clavulanate potassium, cefpodoxime proxetil, and cefprozil) or fluoroquinolone ear drops (ofloxacin, ciprofloxacin). Specimens were obtained from the ears for cultures, and MRSA was present in the cultures. The organisms were resistant to levofloxacin and erythromycin in all patients and resistant to clindamycin hydrochloride in 2 patients. The cultures were sensitive to trimethoprim-sulfamethoxazole, gentamicin sulfate, rifampin, and vancomycin hydrochloride. All patients were treated successfully with oral trimethoprim-sulfamethoxazole and ear drops (gentamicin sulfate or polymyxin B sulfate-neomycin sulfate-hydrocortisone [Cortisporin]).. The rising rate of CA-MRSA as a cause for many pediatric infections is a major concern. It is very important to obtain cultures from patients with nonresponsive or persistent otorrhea with AOM to look for MRSA and determine the sensitivity of the pathogen to antibacterial therapy. Trimethoprim-sulfamethoxazole is a good choice for initial, empirical therapy when combined with a topical agent for AOM with otorrhea if CA-MRSA is suspected. Further studies are needed to determine whether there is a link between the overuse of topical fluoroquinolones in pediatric patients and the recent rising rate of CA-MRSA.

Topics: Acute Disease; Administration, Topical; Anti-Infective Agents; Child; Child, Preschool; Community-Acquired Infections; Female; Humans; Infant; Male; Methicillin Resistance; Middle Ear Ventilation; Otitis Media; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance; Escherichia coli; Humans; Klebsiella pneumoniae; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We investigated the etiology of acute diarrhea among Peruvian military recruits undergoing three months of basic combat training near the Amazonian city of Iquitos. From January through September 2002, 307 of 967 recruits were seen at the Health Post for diarrhea (attack rate [AR] = 31.8%, incidence = 1.28 95% confidence interval [CI] = 1.14-1.43] episodes/person-year). Shigella spp. were the most common bacterial pathogen recovered from recruits experiencing diarrhea episodes. These bacteria were isolated from 89 (40%) of 225 diarrheal stools examined (AR = 7.6%, incidence = 0.30 [95% CI = 0.24-0.38] episodes/person-year). Most (83 of 90; 92%) of the Shigella isolates were S. flexneri, of which 57 (69%) were serotype 2a. Seventy-six percent of Shigella isolates were resistant to sulfamethoxazole/trimethoprim and all were sensitive to ciprofloxacin. Peruvian soldiers may be an excellent population in which to test the efficacy of S. flexneri vaccines in advanced development.

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Ciprofloxacin; Diarrhea; Drug Resistance, Bacterial; Dysentery, Bacillary; Humans; Incidence; Male; Microbial Sensitivity Tests; Military Personnel; Peru; Shigella; Shigella flexneri; Trimethoprim, Sulfamethoxazole Drug Combination

The increasing and comparatively high proportion of uropathogens in Canada resistant to trimethoprim-sulfamethoxazole (TMP-SMX) may be partially responsible for the increasing use of fluoroquinolones. A number of patient-specific variables have been identified as risk factors for infections caused by antibiotic-resistant pathogens. However, variables unrelated to need, have also been associated with receipt of broad-spectrum antibiotics. We identified patient variables associated with receipt of a fluoroquinolone versus TMP-SMX for treatment of acute pyelonephritis.. Healthcare claims from the province of Manitoba, Canada for the period February 1996 to March 1999 were examined to identify episodes of pyelonephritis in non-pregnant females between 18 and 65 years of age treated with TMP-SMX or a fluoroquinolone. Patient variables were identified based on healthcare claims review and data from Statistics Canada. Logistic regression was used to model the probability of receipt of a fluoroquinolone.. A total of 1084 women met inclusion criteria; 653 treated with TMP-SMX and 431 treated with a fluoroquinolone. Age, income, rural residence, recent antibiotic use, recent hospitalization and presentation to an emergency room (ER) were positively associated with receipt of a fluoroquinolone.. Patient variables reportedly associated with an increased probability of resistant organisms (e.g., age, recent antibiotic use and recent hospitalization) were significantly associated with an increased probability of receipt of fluoroquinolones. However, variables unrelated to antibiotic resistance (e.g., income, rural residence and presentation to an ER) were also significantly associated with receipt of a fluoroquinolone.

Topics: Acute Disease; Adolescent; Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; Cohort Studies; Community-Acquired Infections; Drug Resistance, Bacterial; Drug Utilization; Female; Fluoroquinolones; Humans; Insurance Claim Review; Logistic Models; Manitoba; Middle Aged; Pyelonephritis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis is caused by the Gram-negative bacillus Burkholderia pseudomallei. Most clinical reports of disease are from south-east Asia and northern Australia. The organism is intrinsically resistant to most commonly available antibiotics. Standard therapy includes ceftazidime either alone or in combination with co-trimoxazole. The clinical advantage in adding co-trimoxazole has never been determined; nor has the activity of newer, fourth-generation cephalosporins, such as cefepime, been studied in the treatment of this condition. BALB/c mice have been shown to represent an animal model of melioidosis. This animal model was used in this study to compare the efficacy of ceftazidime and cefepime alone or with co-trimoxazole, in the therapy of melioidosis. Antibiotic levels in the mice were determined by HPLC, and dosing was modified to keep plasma antibiotic levels at or above the MIC for the organism-antibiotic combination for a significant part of a 12 h period. Bacterial load, as determined by splenic counts, showed that ceftazidime in combination with co-trimoxazole was the most effective therapeutic option. The animal model described in this study can be used as a preliminary evaluation of therapeutic options for melioidosis.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Cefepime; Ceftazidime; Cephalosporins; Disease Models, Animal; Drug Therapy, Combination; Injections, Intraperitoneal; Melioidosis; Mice; Mice, Inbred BALB C; Trimethoprim, Sulfamethoxazole Drug Combination

At least 250,000 episodes of acute uncomplicated pyelonephritis are treated annually in the emergency department (ED). Trimethoprim-sulfamethoxazole (TMP-SMX) and norfloxacin have both been used as treatments for acute uncomplicated pyelonephritis.. To investigate the cost-effectiveness of two outpatient treatment strategies, TMP-SMX and norfloxacin, for acute uncomplicated pyelonephritis in adult women between the ages of 18 and 65 years.. Common principles of cost-effectiveness analysis were used for this evaluation. The authors developed a decision tree to estimate the costs and effectiveness of two different treatment strategies: TMP-SMX 160/800 mg twice per day for 10 days and norfloxacin 400 mg twice per day for 10 days. The time frame of the decision tree was 11 days. Outcomes were expressed in U.S. dollars, quality-adjusted life-days (QALDs), and dollars per QALD. Sensitivity analyses were performed on most variables.. Norfloxacin is more effective and less costly than the alternative, TMP-SMX. Norfloxacin treatment will save $195.85 per patient, resulting in an aggregate saving of more than $40 million annually. Patients are expected to enjoy a better quality of life with an incremental 0.0601 QALD per patient, if they are treated with norfloxacin. These results are robust across a wide range of probabilities and costs.. In this analysis, norfloxacin 400 mg twice a day was a more cost-effective treatment than TMP/SMX 160/800 mg twice a day for women with pyelonephritis.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents; Anti-Infective Agents, Urinary; Cost-Benefit Analysis; Decision Support Techniques; Female; Health Care Costs; Humans; Middle Aged; Norfloxacin; Pyelonephritis; Quality of Life; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents, Urinary; Drug Eruptions; Humans; Male; Middle Aged; Purpura, Thrombocytopenic; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents, Urinary; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Nitrofurantoin; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Anti-Infective Agents, Urinary; Cephalexin; Drug Resistance, Bacterial; Female; Humans; Pregnancy; Pregnancy Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance, Bacterial; Female; Humans; Practice Guidelines as Topic; Pyelonephritis; Treatment Failure; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

The authors report a fatal case of acute bacterial myocarditis in a nonneutropenic child with acute lymphoblastic leukemia. She was admitted to the hospital with a urinary tract infection resulting from and remained persistently febrile despite resolution of the infection. On hospital day 4 signs of acute cardiac failure developed. Despite aggressive resuscitation measures, she died. Pathologic examination revealed the cause of death to be bacterial myocarditis. In addition, she was found to have a generalized decrease in her serum immunoglobulin levels. Acute bacterial myocarditis in patients with malignancy has been rarely reported. The rapid clinical deterioration and death in the patient in this report is particularly interesting.

Topics: Acute Disease; Agammaglobulinemia; Antineoplastic Combined Chemotherapy Protocols; Cefotaxime; Child; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Myocarditis; Oxacillin; Pericarditis; Pleurisy; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Shoulder Pain; Tobramycin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The authors a case with uveoretinal toxoplasmosis, in a immunocompetent patient. There are some discussions about treatment and evolution in such cases.

Topics: Acute Disease; Adult; Anti-Infective Agents; Antiprotozoal Agents; Drug Therapy, Combination; Female; Humans; Pyrimethamine; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To report a new surgical technique to manage severe acute toxic epidermal necrolysis.. Two interventional case reports.. Two patients. Case 1: A 6-year-old boy had severe toxic epidermal necrolysis develop after being treated with trimethoprim and sulfamethoxazole for chronic otitis media. Both eyes and eyelids were affected. He underwent bilateral lysis of symblepharon and all adhesions and bilateral amniotic membrane transplantation to the entire ocular surface except the cornea. Loss of eyelid skin required transplantation of amniotic membrane to all four eyelids and strips of amniotic membrane at the eyelid margins. Case 2: An 8-year-old girl with severe toxic epidermal necrolysis associated with mycoplasma pneumonia had bilateral, diffuse keratoconjunctivitis, diffuse corneal epithelial defects, and bilateral symblepharon. Amniotic membrane transplantation was performed bilaterally, using a symblepharon ring in the left eye.. Amniotic membrane transplantation.. Preservation of normal ocular and eyelid surfaces and prevention of blindness.. Case 1: Thirty-six months after bilateral ocular surgery, there is no symblepharon, good ocular surface wetting, and an uncorrected bilateral vision of 20/20. Case 2: Amniotic membrane transplantation protected both ocular surfaces and prevented conjunctival contracture without adhesion of the eyelids to the ocular surface. The central vision was preserved. There was minimal peripheral corneal vascularization and mild conjunctival scarring of the tarsal conjunctival surface 34 months postoperatively.. These are the first cases of acute toxic epidermal necrolysis treated with amniotic membrane transplantation and the first use of the procedure on external eyelid surfaces with good healing of the eyelids. This new treatment for acute toxic epidermal necrolysis preserves normal ocular and eyelid surfaces and may prevent blindness.

Topics: Acute Disease; Amnion; Child; Eyelid Diseases; Female; Humans; Keratoconjunctivitis; Male; Ophthalmologic Surgical Procedures; Pneumonia, Mycoplasma; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Q fever, caused by Coxiella burnetii, may result in abortions, premature deliveries, and stillbirths in infected pregnant women.. To evaluate the best treatment strategy for Q fever during pregnancy.. We evaluated the prognosis of 17 pregnant women who developed Q fever with and without co-trimoxazole (trimethoprim-sulfamethoxazole) treatment.. The outcome of the pregnancy was found to depend on the trimester. Abortions occurred in 7 of 7 insufficiently treated patients infected during the first trimester vs 1 of 5 patients infected later. Co-trimoxazole given until delivery protected against abortion (0/4) but not against the development of chronic infections, and it did not significantly reduce the colonization of the placenta (2/4 vs 4/4).. Our results show that C burnetii infections cause abortion and that women who develop Q fever while pregnant should be treated with co-trimoxazole for the duration of pregnancy, specifically when infected during the first trimester.

Topics: Acute Disease; Anti-Bacterial Agents; Chronic Disease; Coxiella burnetii; Female; Follow-Up Studies; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Prognosis; Q Fever; Serologic Tests; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the current management of acute otitis media by New Zealand general practitioners (GPs).. A reply-paid questionnaire was sent to 2000 New Zealand GPs. The questions relate to management of a three year old child presenting with her first episode of acute otitis media.. 95% of respondents reported they would usually or always use antibiotics. Amoxicillin was the antibiotic of choice, followed by amoxicillin/clavulanate. Cotrimoxazole was the antibiotic of choice in the case of allergy to amoxicillin. 82% of respondents recommended follow-up, with a broad range of follow-up times (24 hours to 12 weeks). Approximately half of practitioners considered 5-6 episodes of acute otitis media in a year as an appropriate threshold for referral for grommets. Most GPs had received an update on otitis media within the previous two years.. There is considerable variation in the management of acute otitis media by New Zealand GPs. Use of a national guideline may result in a more standardised, rational approach to the treatment of acute otitis media.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Child, Preschool; Drug Therapy, Combination; Humans; New Zealand; Otitis Media; Penicillins; Physicians, Family; Practice Patterns, Physicians'; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

A retrospective survey was conducted over a 10-year period (1990-99) among 52 haematology divisions in order to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating haematological diseases. The study included 55 patients (18 with non-Hodgkin's lymphoma, 10 with acute lymphoblastic leukaemia, eight with acute myeloid leukaemia, five with chronic myeloid leukaemia, four with chronic lymphocytic leukaemia, four with multiple myeloma, three with myelodysplastic syndrome, two with myelofibrosis and one with thalassemia) who developed PCP. Among these, 18 (33%) underwent stem cell transplantation; only two received an oral prophylaxis with trimethroprim/sulphamethoxazole. Twelve patients (22%) developed PCP despite protective isolation in a laminar airflow room. The most frequent symptoms were: fever (86%), dyspnoea (78%), non-productive cough (71%), thoracic pain (14%) and chills (5%); a severe hypoxaemia was present in 39 patients (71%). Chest radiography or computerized tomography showed interstitial infiltrates in 34 patients (62%), alveolar infiltrates in 12 patients (22%), and alveolar-interstitial infiltrates in nine patients (16%). Bronchoalveolar lavage was diagnostic in 47/48 patients, induced sputum in 9/18 patients and lung biopsy in 3/8 patients. The diagnosis was made in two patients at autopsy. All patients except one started a specific treatment (52 patients trimethroprim/sulphamethoxazole, one pentamidine and one dapsone). Sixteen patients (29%) died of PCP within 30 d of diagnosis. Multivariate analysis showed that prolonged steroid treatment (P < 0.006) and a radiological picture of diffuse lung involvement (P < 0.003) were negative diagnostic factors.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents; Bronchoalveolar Lavage Fluid; Female; Hematologic Neoplasms; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lung; Lymphoma, Non-Hodgkin; Male; Middle Aged; Multiple Myeloma; Multivariate Analysis; Myelodysplastic Syndromes; Pneumonia, Pneumocystis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Primary Myelofibrosis; Radiography; Retrospective Studies; Thalassemia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (T/S) has often been used as first and second line of treatment for acute otitis media (AOM). Because of the increasing resistance of Streptococcus pneumoniae and Haemophilus influenzae to T/S, we undertook the present study to investigate the bacteriologic and clinical efficacy of this drug in AOM.. Fifty-four culture-positive evaluable patients ages 3 to 32 months with AOM were treated with T/S 4/20 mg/kg in two divided daily doses for 10 days. Middle ear fluid (MEF) was cultured at enrollment (Day 1) and on Days 4 and 5 after initiation of treatment. Additional MEF cultures were obtained if clinical relapse occurred. Clinical failure was determined when the symptoms and signs of AOM did not improve or recurred during therapy. Bacteriologic failure was defined by positive culture on Days 4 and 5, or negative on Days 4 and 5 but positive again before the end of treatment. Patients were followed until Day 28 +/- 2.. A total of 67 organisms were isolated from MEF specimens of the 54 study patients: S. pneumoniae, 24; H. influenzae, 40; and Streptococcus pyogenes, 3. Fifteen (63%) of 24 S. pneumoniae were nonsusceptible to T/S (trimethoprim MIC, >0.5 microg/ml), of which 10 (67%) were highly resistant to T/S (trimethoprim MIC, > or = 4.0 microg/ml). Twelve (30%) of 40 H. influenzae and all 3 S. pyogenes isolates were nonsusceptible to T/S (MIC > or = 4.0 microg/ml). Bacteriologic eradication occurred in 9 of 9 (100%) and 27 of 27 (100%) T/S-susceptible S. pneumoniae and H. influenzae, respectively, vs. 4 of 15 (27%) and 6 of 12 (50%) T/S-nonsusceptible S. pneumoniae and H. influenzae, respectively (P < 0.001). The 3 patients with S. pyogenes failed bacteriologically. Nine new organisms, not initially isolated, emerged during treatment, 7 of which (77%) were resistant to T/S. Altogether bacteriologic failure (organisms not eradicated plus newly emerged) occurred in 29 (53%) of 54 patients. Clinical failures occurred in 8 (15%) of 54 patients, and in 7 of these 8 cases the clinical failures occurred in those with bacteriologic failures. Ten patients relapsed clinically after completion of treatment and in 8 of them tympanocentesis for MEF culture was performed. Six of these 8 cultures were positive, and the initial pathogen was isolated in 4 of 6 (67%).. A high bacteriologic failure rate as well as a considerable clinical failure rate occurred among patients with AOM treated with T/S. We believe that T/S is no longer an appropriate empiric choice for the treatment of AOM in regions where high T/S resistance among respiratory pathogens is reported.

Topics: Acute Disease; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Otitis Media; Streptococcus pneumoniae; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of acute respiratory failure due to Toxoplasma gondii mimicking pneumocystosis in an AIDS patient. Empirical antibiotic therapy with cotrimoxazole is discussed. Active research and identification of pathogens with adapted laboratory tests is mandatory.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Anti-Inflammatory Agents; Diagnosis, Differential; Humans; Lung Diseases, Parasitic; Male; Methylprednisolone; Respiratory Insufficiency; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

This retrospective study of patients treated between 1992 and 1996 was undertaken as a preliminary step to identifying the main bacterial causes of diarrheal disease in Libreville, Gabon. A total 371 files showing positive stool cultures were analyzed. From an epidemiological standpoint, data showed that the high risk population was young people of both sexes. The incidence of diarrhea was correlated with climatic conditions with an endemic-epidemic pattern characterized by peak activity during the rainy season. In the vast majority of cases, the underlying etiology was gastroenteritis due to invasive organisms. The most commonly identified agents were salmonellae (46.6%) and Shigellae (44.2%). Treatment should focus on rehydration. Fluoro-quinolones were the most commonly indicated drugs for antimicrobial treatment but cotrimoxazole was often useful. In general, the prognosis of bacterial diarrhea is favorable provided that it is treated early and concurrent conditions are taken into account.

Topics: Acute Disease; Adult; Anti-Infective Agents; Bacterial Infections; Diarrhea; Dysentery, Bacillary; Feces; Female; Fluoroquinolones; Gabon; Humans; Male; Retrospective Studies; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Agglutination Tests; Anti-Bacterial Agents; Anti-Infective Agents; Brucellosis; Child; Enzyme-Linked Immunosorbent Assay; Gentamicins; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the effect of age, severity of lung disease, severity and frequency of exacerbation, steroid use, choice of an antibiotic, and the presence of comorbidity on the outcome of treatment for an acute exacerbation of COPD.. A retrospective chart analysis over 24 months.. A university Veterans Affairs medical center.. Outpatients with COPD who were treated with an antibiotic over a period of 24 months for an acute exacerbation of COPD.. Severity of an acute exacerbation of COPD was defined using the criteria of Anthonisen et al: increased dyspnea, increased sputum volume, and increased sputum purulence. Severity of lung disease was stratified based on FEV(1) percent predicted using American Thoracic Society guidelines (stage I, FEV(1) > or = 50%; stage II, FEV(1) 35 to 49%; stage III, FEV(1) < 35%). Treatment outcome was judged successful when the patient had no return visit in 4 weeks for a respiratory problem. Failure was defined as a return visit for persistent respiratory symptoms that required a change of an antibiotic in < 4 weeks.. One-hundred seven patients with COPD (mean age +/- SD, 66.9 +/- 9.5 years) experienced 232 exacerbations over 24 months. First-line antibiotics (trimethoprim-sulfamethoxazole, ampicillin/amoxicillin, and erythromycin) were used to treat 78% of all exacerbations. Treatment failure was noted in 12.1% of first exacerbations and 14. 7% of all exacerbations, with more than half the failures requiring hospitalization. Host factors that were independently associated with treatment failure included the following: FEV(1) < 35% (46.4% vs 22.4%; p = 0.047), use of home oxygen (60.7% vs 15.6%; p < 0. 0001), frequency of exacerbation (3.8 +/- 2.0 vs 1.6 +/- 0.91; p < 0. 001), history of previous pneumonia (64.3% vs 35.1 p < 0.007), history of sinusitis (28.6% vs 8.8%; p < 0.009) and use of maintenance steroids (32.1% vs 15.2% p = 0.052). Using stepwise logistic regression analysis to identify the top independent variables, the use of home oxygen (p = 0.0002) and frequency of exacerbation (p < 0.0001) correctly classified failures in 83.3% of the patients. Surprisingly, age, the choice of an antibiotic, and the presence of any one or more comorbidity did not affect the treatment outcome.. The results of our study suggest that patient host factors and not antibiotic choice may determine treatment outcome. Prospective studies in appropriately stratified patients are needed to validate these findings.

Topics: Acute Disease; Adrenal Cortex Hormones; Aged; Ambulatory Care; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Comorbidity; Erythromycin; Female; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

The diagnosis of acute sinusitis has been regarded as a serious condition that requires the use of antibiotics. However the increasing incidence of resistant organisms means antibiotics need to be used carefully.. To look at the evidence available regarding antibiotic use for sinusitis, and to discuss its application to general practice.. There have been surprisingly few randomised double blind placebo controlled trials for sinusitis, and fewer still have been based in a representative population of primary care patients. This article discusses studies relevant to general practice. Several practical clinical symptoms and signs have been shown to increase the likelihood of a patient having acute bacterial sinusitis, and therefore benefit from antibiotics. When antibiotics are used, comparative data suggest that amoxycillin should be used first line. The issue of patient experience, expectations and satisfaction is also raised.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Endoscopy; Humans; Patient Selection; Penicillins; Randomized Controlled Trials as Topic; Sinusitis; Time Factors; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

The development of a rash in response to trimethoprim-sulfamethoxazole (TMP-SMX) administration is a frequent adverse reaction in people with the acquired immunodeficiency syndrome (AIDS). In contrast, there are no published reports in the English language literature describing TMP-SMX induced delirium in an AIDS patient. This report describes the development of frank delirium in a person with AIDS receiving TMP-SMX. The episode resolved completely within 72 h of withdrawal of the drug.

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Infective Agents; Delirium; Drug Therapy, Combination; Histoplasmosis; Humans; Male; Middle Aged; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Otitis media occurs commonly in children, and is usually treated with an antibiotic. In this case report, amoxicillin was prescribed for a 6-year-old boy suffering from acute otitis media. As he had previously experienced a rash after the administration of a penicillin, the medication order was switched from amoxicillin to trimethoprim/sulfamethoxazole (TMP/SMX). In an effort to determine whether or not this intervention was appropriate, references were found using Medline, International Pharmaceutical Abstracts and the Cochrane Library. Issues to be addressed included the need for antibiotics in acute otitis media, the comparative efficacy and tolerability of antimicrobial agents and the reliability of reported penicillin allergies. Amoxicillin and TMP/SMX were found to be first-line agents in the treatment of acute otitis media owing to their efficacy, safety and cost, with neither drug being significantly better than the other. The need to treat otitis media with antibiotics remains controversial. Reported penicillin allergies were found to be an unreliable indicator of a potentially serious reaction. In conclusion, it was found that treatment with TMP/SMX was an appropriate intervention.

Topics: Acute Disease; Anti-Infective Agents; Child; Databases, Factual; Drug Eruptions; Humans; Male; Otitis Media; Penicillins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To recommend a cost-effective approach for the management of acute male urethritis in the developing world, based on the findings of a theoretical study.. A model was developed to assess the cost-effectiveness of three urethritis management strategies in a theoretical cohort of 1000 men with urethral syndrome. (1) All patients were treated with cefixime and doxycycline for gonococcal urethritis (GU) and nongonococcal urethritis (NGU), respectively, as recommended by WHO. (2) All patients were treated with doxycycline for NGU; treatment with cefixime was based on the result of direct microscopy of a urethral smear. (3) All patients were treated with cotrimoxazole or kanamycin for GU and doxycycline for NGU. Cefixime was kept for patients not responding to the first GU treatment. Strategy costs included consultations, laboratory diagnosis (where applicable) and drugs. The outcome was the rate of patients cured of urethritis. Cost-effectiveness was measured in terms of cost per cured urethritis.. Strategy costs in our model depended largely on drug costs. The first strategy was confirmed as the most effective but also the most expensive approach. Cefixime should cost no more than US$ 1.5 for the strategy to be the most cost-effective. The second strategy saved money and drugs but proved a valuable alternative only when laboratory performance was optimal. The third strategy with cotrimoxazole was the least expensive but a low follow-up visit rate, poor treatment compliance or lower drug efficacy limited effectiveness. Maximizing compliance by replacing cotrimoxazole with single-dose kanamycin had the single greatest impact on the effectiveness of the third strategy.. Our model suggested that a cost-effective approach would be to treat gonorrhoea with a single-dose antibiotic selected from locally available products that cost no more than US$ 1.5.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Cefixime; Cost-Benefit Analysis; Decision Trees; Developing Countries; Doxycycline; Drug Costs; Drug Therapy, Combination; Follow-Up Studies; Gonorrhea; Humans; Kanamycin; Male; Sensitivity and Specificity; Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Recurrent infection after an episode of otitis media is common in pediatric patients. If a patient experienced primary treatment failure in a preceding episode, physicians often feel pressured to prescribe a broad-spectrum, second-line agent for the next episode rather than a first-line drug. The purpose of our study was to determine whether using a second-line drug resulted in fewer treatment failures in a recurrent otitis episode following an episode of apparent resistance.. The Practice Partner Research Network database, a national research network of practices that use the same electronic medical record, was reviewed to identify all primary episodes of otitis media over a 2-year period (N = 7807). From this, 1416 pediatric patients with presumed treatment failures were identified. The subset of those with a second otitis media episode more than 90 days after the index episode (N = 343) was selected for study. Of this group, 236 (69%) received first-line antibiotics (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) and the remaining 107 received a broader-spectrum, second-line antibiotic. The primary outcome was the need for an additional antibiotic for otitis media within the next 45 days.. Patients receiving first- and second-line antibiotics did not differ in sex or age. However, those receiving second-line antibiotics had a shorter duration between episodes (231 vs 280 days, P = .007). Failure rates for first- and second-line antibiotics in recurrent episodes were not significantly different (13% vs 19%, P = .20). Because the duration between episodes could have affected failure rates, we stratified the time between episodes into short, intermediate, and long duration. Second-line antibiotics were not superior to first-line drugs in any stratum.. For a new otitis media episode in a patient with a previous treatment failure, first-line drugs (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) are just as effective as broader-spectrum, more expensive, second-line antibiotics.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Otitis Media; Penicillins; Recurrence; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

The Pakistan program for control of acute respiratory tract infections (ARIs) adopted the standard ARI-case-management strategy of the World Health Organization and recommended co-trimoxazole for the management of nonsevere pneumonia. Reports in that country of high in vitro antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae to co-trimoxazole prompted the program to reevaluate its treatment policy. Two community-based studies during 1991-1993 showed in vivo efficacy of co-trimoxazole in 92% and 91% of children with nonsevere pneumonia. A third double-blind trial showed co-trimoxazole and oral amoxicillin to be equally effective in vivo in cases of nonsevere pneumonia, despite high in vitro resistance. Country-wide surveillance from 1991 to 1994 revealed 78.3%-79.9% in vitro resistance to co-trimoxazole among S. pneumoniae isolates and 59.5%-61.0% among H. influenzae isolates. Co-trimoxazole is still recommended by the Pakistan ARI control program. The fact that amoxicillin is three times more expensive and must be administered more frequently is a big impediment to recommending it as a first-line drug for nonsevere pneumonia.

Topics: Acute Disease; Anti-Bacterial Agents; Developing Countries; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Pakistan; Pneumococcal Infections; Respiratory Tract Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Drug-induced acute interstitial nephritis is a common cause of dysfunction in native kidneys, but is rarely reported in renal allografts. This report describes six renal transplant recipients with acute renal allograft dysfunction or delayed allograft function in whom a renal transplant biopsy showed histopathologic features of drug-induced interstitial nephritis with no diagnostic evidence of acute rejection, cyclosporine or tacrolimus nephrotoxicity, or other lesion that could account for the graft dysfunction. In five of the six patients, interstitial nephritis occurred within 4 weeks of transplantation. All the patients were receiving trimethaprim-sulfamethoxazole and/or other drugs associated with interstitial nephritis. After discontinuation of these drugs and short-term corticosteroid treatment, all patients showed improvement in renal function, although the time course of this improvement varied considerably, with three patients showing a return to baseline serum creatinine level within 2 weeks and two patients showing a gradual improvement over 8 weeks. Four of the five patients followed up for more than 1 year (range, 14 to 33 months) after the episode of interstitial nephritis had good allograft function (serum creatinine level

Topics: Acute Disease; Adult; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Female; Graft Rejection; Humans; Kidney; Kidney Transplantation; Male; Middle Aged; Nephritis, Interstitial; Postoperative Complications; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Animals; Anti-Infective Agents; Cell Line; Child, Preschool; Exanthema; Fever; Humans; Influenza A virus; Influenza, Human; Macaca mulatta; Male; Purpura; Trimethoprim, Sulfamethoxazole Drug Combination

To characterize clinical, diagnostic and course features of pneumonia caused by Pneumocystis carinii (PC) in hematologic inpatients.. 27 patients with blood diseases were studied. 22 of them had acute respiratory insufficiency and 5 had unclear lung affection. The data from bronchoalveolar lavage (BAL), lung biopsy, serum tests for IgG, IgM anti-PC-antibodies were used for diagnosis of PC-pneumonia.. PC-pneumonia was diagnosed in 8 of 27 patients. Clinical manifestations characteristic for PC-pneumonia were not found. In 5 patients the diagnosis was made on the evidence provided by BAL. Lymphocyte count in BAL was elevated to 27.7 +/- 8.7%. Open biopsy of the lung and transbronchial biopsy diagnosed PC-pneumonia in 2 and 1 patients, respectively. Previous BAL examinations failed to detect PC-pneumonia in 2 of them. In all the patients PC-pneumonia was associated with another infection (bacterial, cytomegaloviral). Histologically, the picture of the disease was determined by the severity of the lung affection or its complications. 5 of 8 patients failed treatment with trimethoprim-sulphamethoxazole and died. Marked respiratory insufficiency was registered at PC-pneumonia diagnosis in all the lethal cases.. Clinical and x-ray pictures of PC-pneumonia in hemoblastosis patients are not specific. All such patients with symptoms of lung infection resistant to antibacterial and antifungal therapy should be examined for PC-pneumonia.

Topics: Acute Disease; Adolescent; Adult; Aged; Anemia, Aplastic; Anemia, Refractory, with Excess of Blasts; Anti-Infective Agents; Biopsy; Bronchoalveolar Lavage Fluid; Female; Hematologic Diseases; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lung; Lymphoproliferative Disorders; Male; Middle Aged; Multiple Myeloma; Pneumonia, Pneumocystis; Radiography, Thoracic; Respiratory Insufficiency; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of two specific types of urinary tract infections (UTIs): uncomplicated, acute, symptomatic bacterial cystitis and acute pyelonephritis in women. The guideline does not contain recommendations for asymptomatic bacteriuria, complicated UTIs, Foley catheter-associated infections, UTIs in men or children, or prostatitis. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent women. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members represented experts in adult infectious diseases and urology. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendation and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council, the sponsor and supporter of the guideline. The American Urologic Association and the European Society of Clinical Microbiology and Infectious Diseases have endorsed it. An executive summary and tables highlight the major recommendations. Performance measures are described to aid in monitoring compliance with the guideline. The guideline will be listed on the IDSA home page at http://www.idsociety.org It will be evaluated for updating in 2 years.

Topics: Acute Disease; Anti-Infective Agents; Bacterial Infections; Cystitis; Female; Fluoroquinolones; Humans; Nitrofurantoin; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination

Seventy-three cases of acute brucellosis were studied in relation to fever duration and hospital stay following different drug combinations, including gentamicin plus cotrimoxazole, rifampicin plus doxycycline, rifampicin plus cotrimoxazole, rifampicin plus tetracycline, streptomycin plus doxycycline, doxycycline plus cotrimoxazole, tetracycline plus cotrimoxazole, and tetracycline plus streptomycin. No statistical significant difference was found between these combinations regarding early clinical response in human brucellosis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Child; Child, Preschool; Doxycycline; Female; Gentamicins; Humans; Infant; Male; Middle Aged; Retrospective Studies; Rifampin; Streptomycin; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Audiometry; Bone Conduction; Cefuroxime; Cephalosporins; Ciprofloxacin; Drug Therapy, Combination; Facial Paralysis; Female; Follow-Up Studies; Glucocorticoids; Hearing Loss; Hearing Loss, Conductive; Humans; Male; Middle Aged; Otitis Media; Penicillins; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination; Tympanic Membrane

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Brain Neoplasms; Consciousness Disorders; Disease Susceptibility; Fatal Outcome; Hallucinations; Humans; Lymphoma, AIDS-Related; Male; Pneumonia, Pneumocystis; Psychoses, Substance-Induced; Sulfadiazine; Toxoplasmosis, Cerebral; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents; Ciprofloxacin; Diverticulitis, Colonic; Drug Therapy, Combination; Humans; Metronidazole; Trimethoprim, Sulfamethoxazole Drug Combination

During 1995 and 1996, 393 and 566 strains of Streptococcus pneumoniae, isolated from acute otitis media, were respectively sent to the National Reference Center for Pneumococci by its corresponding centers.. The resistance rates for 1995 and 1996 were respectively: for penicillin: 65.4 and 70.3% (18.6 and 24.9% of intermediately resistant strains, 46.8 and 45.4% of fully resistant strains), for erythromycin: 57.5 and 68.5%, for tetracycline: 43.2 and 42.6%, for trimethoprim-sulfamethoxazole: 47.5 and 50.9%. Minimal inhibitory concentrations (MICs) of various betalactams were determined against a representative sample of strains (n = 99).. Amoxicillin, cefpodoxime and cefuroxime MICs remained low against numerous penicillin resistant strains, indicating that these three oral antibiotics (in combination with clavulanate for amoxicillin) have a useful potential for the treatment of acute otitis media when risk factors for pneumococcal penicillin-resistant infections are detected.

Topics: Acute Disease; Amoxicillin; beta-Lactam Resistance; beta-Lactams; Cefpodoxime; Ceftizoxime; Cefuroxime; Erythromycin; France; Humans; Microbial Sensitivity Tests; Otitis Media; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the epidemiologic, clinical, radiologic, laboratory and treatment characteristics of acute pneumonia and its association with mortality in HIV-infected children.. Data were collected during a trial of intravenous immunoglobulin (IVIG) for infection prophylaxis (1988 to 1991); CD4+ percentage was measured and HIV RNA was assessed on stored sera collected at baseline and every 3 months. Mortality was recorded during the trial and updated through 1996. All reported physician-diagnosed pneumonia episodes underwent blinded review for trial endpoint classification as acute (new radiologic findings and presence of clinical symptoms) or nonacute.. On blinded clinical trial endpoint review of all reported pneumonia episodes (n = 281), only 47% were classified as acute. One hundred thirty-one episodes of acute pneumonia were reported in 93 children (47 in 31 IVIG and 84 in 62 placebo patients, P < 0.01). The incidence of acute pneumonia was 24 episodes per 100 patient years. Findings associated with an acute bacterial process were uncommon (leukocytosis > or =15000/mm3 in 21% and fever > or =103 degrees F in 32% of episodes). Multiple acute episodes occurred in 34% of the children and were associated with increased risk of mortality in a univariate analysis (risk ratio, 2.1; 95% confidence interval, 1.3 to 3.4, P = 0.002), but in a multivariate model only baseline HIV RNA copy number and CD4+ percentage remained independently associated with mortality (relative risk, 2.0 and 1.4, respectively, P < 0.001).. Acute pneumonia was a common occurrence in HIV-infected children and was associated with long term mortality risk. Multiple episodes of acute pneumonia likely represent a marker of progressive disease and immunologic dysfunction rather than being causally associated with increased long term mortality.

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Bacterial Infections; CD4 Lymphocyte Count; Child; Child, Preschool; Clinical Trials as Topic; Female; HIV Infections; Humans; Immunoglobulins, Intravenous; Infant; Male; Pneumonia; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load

Topics: Acute Disease; Adult; Anti-HIV Agents; Drug Therapy, Combination; HIV Infections; HIV Protease Inhibitors; Humans; Hypertriglyceridemia; Male; Pancreatitis; Reverse Transcriptase Inhibitors; Ritonavir; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

Acute otitis media is the most common bacterial infection in the child under 5 years of age and the leading reason for antibiotic prescriptions in Western countries. The choice of optimal antibiotic treatment is based essentially on microbiologic epidemiologic studies. The bacteria most often responsible for otitis belong to the commensal flora of the nasopharynx. French studies using paracentesis show that the main bacteria responsible for acute otitis media are H. influenzae, S. pneumoniae and M. catarrhalis. The epidemiology of resistance to antibiotics has recently changed, with the appearance of pneumococcal strains having reduced sensitivity to penicillin, and which have played a major role in treatment failures.

Topics: Acute Disease; Age Factors; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Erythromycin; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Moraxella catarrhalis; Nasopharynx; Otitis Media; Penicillin G; Penicillin Resistance; Penicillins; Seasons; Staphylococcus aureus; Streptococcus pneumoniae; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Bacterial Agents; Cystitis; Escherichia coli; Female; Fosfomycin; Humans; Randomized Controlled Trials as Topic; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States. However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing.. The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were

Topics: Acute Disease; Adolescent; Amoxicillin; Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Cohort Studies; Colorado; Drug Combinations; Drug Costs; Drug Utilization; Erythromycin; Female; Humans; Infant; Male; Medicaid; Otitis Media; Practice Patterns, Physicians'; Sulfisoxazole; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Topics: Acute Disease; Anti-Infective Agents; Child; Cost-Benefit Analysis; Health Maintenance Organizations; Humans; Otitis Media; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Topics: Aclarubicin; Acute Disease; Adult; Amsacrine; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Cohort Studies; Cyclophosphamide; Cytarabine; Daunorubicin; Dexamethasone; Etoposide; Female; Finland; Humans; Immunocompromised Host; Incidence; Leukemia; Male; Mercaptopurine; Methotrexate; Middle Aged; Mitoxantrone; Pneumonia, Pneumocystis; Prednisone; Premedication; Retrospective Studies; Thioguanine; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

Acute otitis media, a common childhood disorder, is an inflammation of the middle ear. It is the most frequent diagnosis made in primary care settings for children under 15 years of age. Almost all children are afflicted with at least one episode of otitis media before age 6. Diagnosis can often be challenging, especially in infants and toddlers. Moreover, management controversies exist. This article addresses the epidemiology, clinical presentation, and diagnosis of acute otitis media and presents treatment options based on results of recent research. When a child is diagnosed with acute otitis media, it behooves the clinician to use sound research-based clinical judgment in prescribing treatment.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination; United States

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

Topics: Acute Disease; Anti-Infective Agents; Humans; Maxillary Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents; Drug Administration Schedule; Humans; Maxillary Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents; Drug Administration Schedule; Humans; Maxillary Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

Two children who presented with fever, thrombocytopenic purpura and mucosal haemorrhages proved to have brucellosis. Large platelets in the peripheral smear and megakaryocytic hyperplasia in the bone marrow suggested increased peripheral destruction as the primary mechanism of the thrombocytopenia. There was a prompt clinical and haematological response to specific anti-brucella chemotherapy. The nature of this association and its implications for brucella-endemic areas are discussed.

Topics: Acute Disease; Blood Platelets; Bone Marrow; Brucellosis; Child; Child, Preschool; Diagnosis, Differential; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Megakaryocytes; Platelet Count; Purpura, Thrombocytopenic; Rifampin; Saudi Arabia; Trimethoprim, Sulfamethoxazole Drug Combination

During 1991-94 we treated 51 patients with acute myeloid leukaemias and 3 patients with a myelodysplastic syndrome of refractory anaemia with excess of blasts in transformation. The patients received trimethoprim-sulphamethoxazole (TMP-SMX) 1,920 mg daily as a prophylaxis of Pneumocystis carinii infections and selective decontamination of gastrointestinal tract. The majority of patients received TMP-SMX in their first course of chemotherapy with daunorubicin and cytosine arabinoside. Only one of the 18 patients without TMP-SMX prophylaxis during the first course of chemotherapy developed Pneumocystis carinii pneumonia. That pneumonia was successfully treated by intravenous administration of TMP-SMX 1920 mg four times a day. No other Pneumocystis carinii infection was encountered in all other patients during their clinical follow up or in autopsy material of expired patients. TMP-SMX prophylaxis had to be interrupted in 11 patients due to their suspicious allergic skin reactions, however, TMP-SMX was readministered in all without any skin changes attributable to TMP-SMX during next cycles of chemotherapy. TMP-SMX in a given daily dose of 1,920 mg seems to be a successful prophylaxis of Pneumocystis carinii infections in patients with malignant diseases of hematopoiesis.

Topics: Acute Disease; Adult; Anemia, Refractory, with Excess of Blasts; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Opportunistic Infections; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Empiric treatment with ciprofloxacin and norfloxacin has been recommended recently for patients with acute diarrhoeal disease. In a retrospective 6-month study period the results of stool cultures from 209 patients with acute diarrhoea admitted to the emergency room were analysed. Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonnei comprised 72% and Shigella flexneri 19% of all the bacterial isolates. While no antimicrobial resistance to ciprofloxacin was found for both Shigella species, only 36 and 26% of the Shigella isolates were sensitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), respectively. These findings point out to the emergence of drug resistance to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fact that indiscriminate use of this drug could result in the emergence of resistance similar to that noted with ampicillin and TMP-SMZ.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Bacteriological Techniques; Child; Child, Preschool; Ciprofloxacin; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Emergency Service, Hospital; Escherichia coli Infections; Feces; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of probable pentamidine-induced acute pancreatitis.. A patient was hospitalized because of fever, dyspnea, and productive cough. Chest X-ray revealed diffuse alveolar infiltrates, and the examination of bronchoalveolar lavage demonstrated the presence of Pneumocystis carinii. Intravenous cotrimoxazole was administered but the patient's condition did not improve. As secondary leukopenia appeared, the treatment was changed to pentamidine isethionate 4 mg/kg/d i.v. On day 5 of this new therapy, the patient experienced abdominal pain, and both blood and urine amylase concentrations raised to 330 U/L and 3960 U/L, respectively. The patient died 48 hours later, and signs of acute pancreatitis were observed in necropsy.. With reference to a classical method for estimating the probability of adverse drug reactions, a probable relationship between pentamidine therapy and acute pancreatitis was found in this patient. Furthermore, no alternative causes of pancreatitis were present.. It is likely that pentamidine administration in our patient resulted in an acute episode of pancreatitis. Serum and urine amylase concentrations should be monitored in patients receiving this drug.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Humans; Male; Methylprednisolone; Pancreatitis; Pentamidine; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

During a community-based study in four rural villages in Pakistan, 617 cases of acute respiratory infections (ARI) in children younger than 5 years of age were assessed, classified and managed according to the WHO ARI case management guidelines. Of these, 509 (82.5%) had 'cough and cold' without clinical evidence of pneumonia, 95 pneumonia, two severe pneumonia and 11 otitis media. Of the 509 without clinical evidence of pneumonia but with cough and cold, 491 (96.5%) were successfully treated without antibiotics and only 18 (3.5%) of these children needed antimicrobial therapy on follow-up. Of the 95 cases of pneumonia, 87 (91.4%) showed a satisfactory clinical response to oral cotrimoxazole and only eight (8.4%) required a change of antibiotic.

Topics: Acute Disease; Amoxicillin; Ampicillin; Child, Preschool; Common Cold; Drug Combinations; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Pakistan; Pneumonia; Practice Guidelines as Topic; Respiratory Tract Infections; Rural Health; Trimethoprim, Sulfamethoxazole Drug Combination; World Health Organization

The relation of acute thrombocytopenic purpura (TP) to the use of drugs was investigated in a case-control study conducted in eastern Massachusetts, Rhode Island, and the Philadelphia region; 62 cases over the age of 16 years with acute onset and with a rapid recovery were compared with 2,625 hospital controls. After control for confounding by multiple logistic regression, use of the following drugs in the week before the onset of symptoms was significantly associated: trimethoprim/sulfamethoxazole (relative risk [RR] estimate, 124), quinidine/quinine (101), dipyridamole (14), sulfonylureas (4.8), and salicylates (2.6). The overall annual incidence of acute TP was estimated to be 18 cases per million population. The excess risks for the associated drugs were estimated to be 38 cases per million users of trimethoprim/sulfamethoxazole per week, 26 per million for quinidine/quinine, 3.9 per million for dipyridamole, 1.2 per million for sulfonylureas, and 0.4 per million for salicylates. Associations with sulfonamides, quinidine/quinine, sulfonylureas, and salicylates have been previously reported, but the present study has provided the first quantitative measures of the risk. The association with dipyridamole was unexpected. In general, despite large RRs, the incidence rates attributable to the drugs at issue (excess risks) were low, suggesting that TP is not an important consideration in the use of the various drugs.

Topics: Acute Disease; Adult; Case-Control Studies; Dipyridamole; Female; Humans; Male; Purpura, Thrombocytopenic; Quinidine; Risk; Trimethoprim, Sulfamethoxazole Drug Combination

Infections are still a frequent cause of morbidity in patients with hematologic malignancies. Until 10 years ago the microorganisms most frequently encountered were aerobic gram-negative bacilli, which in many centers were responsible for, on average, one infection per neutropenic period. Many different approaches to the prevention of these infections have been designed. Patients have been kept in strict isolation and given broad-spectrum antibiotics prophylactically. This approach has led to a decrease in the incidence of infections in these patients, but compliance and emergence of resistance have been important limiting factors. The rationale of selective decontamination with trimethoprim-sulfamethoxazole or quinolones was that the elimination of potentially pathogenic aerobic gram-negative bacilli from the gastrointestinal tract would prevent colonization and subsequent infection. The use of these antibiotics has led to a shift in the spectrum of infections. Infections due to gram-negative bacilli have been virtually eliminated, but the number of infections caused by gram-positive bacteria is rapidly increasing; however, the latter infections are most often only minor. In some centers quinolones are now used together with agents active against these gram-positive bacteria. The approach of selective decontamination has not led to fewer febrile episodes or to a lower mortality in neutropenic patients. Future studies should be directed towards identifying the cause of febrile episodes and the epidemiology of gram-positive bacterial infections.

Topics: Acute Disease; Bacterial Infections; Communicable Diseases; Humans; Infection Control; Leukemia; Neutropenia; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination

This report describes the occurrence of acute transient myopia in a patient treated with sulfonamide. We followed this patient by performing A-scan ultrasonographic ocular measurements documenting the anterior chamber depth, lens thickness, and axial length during the acute and convalescent periods. The outstanding feature in this case was the documented ultrasonographically significant reduction of the anterior chamber depth combined with lens thickening. This could be caused by a forward displacement of the lens as a result of allergic ciliary body edema and rotation. These changes could explain the mechanism of drug-induced transient myopia.

Topics: Acute Disease; Administration, Oral; Adult; Anterior Chamber; Anthropometry; Cystitis; Female; Humans; Myopia; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Topics: Acute Disease; Child; Child, Preschool; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Gastroenteritis; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

We have reported a case of sulfonamide-induced acute pancreatitis. A review of the literature showed only eight previously reported cases. Adverse reactions to sulfonamides are well known, but acute pancreatitis is a very serious complication. If evidence of pancreatic involvement occurs during sulfonamide therapy, the medication should be discontinued immediately and, if necessary, be replaced by an alternative. Other causes of pancreatitis must be excluded.

Topics: Acute Disease; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Brain Abscess; Endoscopy, Digestive System; Humans; Male; Middle Aged; Nocardia Infections; Pancreatitis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A case of adverse side effects of co-trimoxazole (Biseptol) was observed, with predominance of neurological changes in the clinical picture. Attention is called to the infrequent occurrence of such side effects of this drug and to the necessity of prompt diagnostic and therapeutic management of such cases.

Topics: Acute Disease; Adult; Bronchitis; Combined Modality Therapy; Disorders of Excessive Somnolence; Drug Hypersensitivity; Headache; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a survey over a 21-year period of the incidence and risk of occurrence of episodes of pneumonia and pneumonitis in children treated for solid tumours and leukaemia. One hundred episodes occurred amongst 219 patients, seven of which were associated with death. Focal opacification on the chest radiograph was more common than diffuse opacification. Patients with leukaemia had a significantly higher rate of occurrence of pneumonia and pneumonitis during the periods of induction and maintenance compared with the off-treatment period, and during the relapse period compared with the period of maintenance. Patients with solid tumours had a significantly higher rate of occurrence during treatment compared to the off-treatment period. The rate of occurrence on treatment was the same in patients with solid tumours and acute leukaemia. Children with malignancy have a high incidence of pneumonia and pneumonitis and death is rare if the patient does not have terminal malignant disease.

Topics: Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bacterial Infections; Child; Clinical Protocols; Daunorubicin; Humans; Immunocompromised Host; Leukemia; Methotrexate; Neoplasms; Opportunistic Infections; Pneumonia; Pneumonia, Viral; Prednisolone; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

The clinical effects of Nifuroxasid (N), Trimetoprim sulphametoxasol (TS) and Bactisubtil (B) on bacillar dysentery and alimentary toxicoinfections in the patients treated at the Clinic from January 1984 to the end of December 1989 have been analysed. According to the clinical signs, patients have been divided in ten categories of light, mild and heavy forms. In total, 329 cases of bacillar dysentery and 89 cases of alimentary toxicoinfections have been analysed. The following was established: A. Bacilar dysentery: the fastest normalization of the stool was achieved with N in every clinical form (averages 2.2, 3.5 and 4.05 days). With TS the effects were slower (3.0, 3.9 and 4.4 days), but the slowest normalization was recorded with B (3.4, 4.6 and 5.4 days). However, with TS, some Shigella strains showed resistance (in 23 out of 94 antibiograms), which diminished the effects. B. Alimentary toxicoinfections were treated only with N and B, since these forms of diarrhea caused by toxigenic factors were milder. Better results were achieved with N in this case as well.

Topics: Acute Disease; Adjuvants, Immunologic; Anti-Infective Agents; Bacillus subtilis; Biological Factors; Diarrhea; Dysentery, Bacillary; Foodborne Diseases; Humans; Hydroxybenzoates; Nitrofurans; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Aged; Amdinocillin Pivoxil; Humans; Pivampicillin; Pyelonephritis; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Female; Humans; Norfloxacin; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adult; Humans; Hypotension; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adolescent; Anti-Infective Agents; Bacteria; Bacterial Infections; Chloramphenicol; Diarrhea; Feces; Female; Humans; Male; Norfloxacin; Quinolones; Randomized Controlled Trials as Topic; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Child; Cost-Benefit Analysis; Drug Combinations; Humans; Otitis Media; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

To optimize the therapeutic approach to acute pyelonephritis (PNA), the medical records of 89 patients (73 women and 16 men) hospitalized with diagnosis of PNA between January 1984 and 1987 have been studied. According to routine bacteriological urinalysis, gram-negatives were found in more than 92% (E. coli in 79%, Proteus in 6%). Gram-positives were found in only 8%. The gram-negatives (n = 82) showed resistance to amoxicillin in 36%, to amoxicillin/clavulanic acid in 17%, to cotrimoxazole in 18%, and to ceftriaxone in 1%. No resistance to netilmicin or norfloxacin was found. These results justify treatment with norfloxacin or ceftriaxone instead of amoxicillin, amoxicillin/clavulanic acid or cotrimoxazole for gram-negatives. Among the 7 cases with gram-positives, resistance was found to amoxicillin/clavulanic acid, cotrimoxazole and also netilmicin, and to norfloxacin, ceftriaxone and amoxicillin. Therefore, an initial therapy using the association amoxicillin-netilmicin is recommended in PNA.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Clavulanic Acids; Drug Resistance, Microbial; Female; Gram-Negative Bacteria; Male; Microbial Sensitivity Tests; Netilmicin; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of recurrent varicella-zoster virus infection in a patient with severe acquired immune deficiency syndrome in whom the infection has become clinically unresponsive to treatment with acyclovir.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Adult; Drug Combinations; Drug Therapy, Combination; Herpes Zoster; Herpesvirus 3, Human; Homosexuality; Humans; Immune Tolerance; Male; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The effect of a single day treatment with 600 mg norfloxacin 600 mg ofloxacin or 1,920 mg trimethoprim-sulfamethoxazol was determined on 114 patients with acute cystitis. The overall clinical efficacy was excellent in 101 patients (89%), moderate in 9 patients (8%) and poor in 4 patients (3%). Recurrence was observed in 8 cases (8%) within 6 weeks after the treatment. The effectiveness rate and the recurrence rate were inferior in those caused by S. epidermidis compared with those caused by E. coli.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Cystitis; Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Middle Aged; Norfloxacin; Ofloxacin; Recurrence; Staphylococcal Infections; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The response of 310 patients with typhoid or paratyphoid fevers to current antibiotic therapy was studied retrospectively. Most patients were of Asian or European origin, thus reflecting the areas in which they were infected. Of the 244 patients with well-recorded therapy 63% were treated with chloramphenicol, 22% with co-trimoxazole and the remainder with various penicillins. There was little difference in response in terms of resolution of fever. Symptoms persisted in only two of 153 (1.3%) patients given chloramphenicol but side-effects led to a change of treatment in nine of these patients. Co-trimoxazole was not significantly inferior and amoxycillin performed well, but the small number of cases treated with ampicillin or mecillinam did not respond as well as those treated with the other drugs.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Drug Combinations; Female; Humans; Male; Middle Aged; Netherlands; Paratyphoid Fever; Retrospective Studies; Sulfamethoxazole; Surveys and Questionnaires; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; United Kingdom

A 17-year-old schoolboy was admitted to hospital because of one-sided pelvic pain of uncertain aetiology and fever gradually rising over several days. Bacteriological analysis of blood cultures, skeletal scintigraphy and computed tomography revealed sacroiliitis caused by Salmonella cholerae-suis. Specific antibiotic treatment quickly stopped all symptoms and cured the infection. Radiologically there remained sclerosis of the sacro-iliac joint.

Topics: Acute Disease; Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Arthritis, Infectious; Clavulanic Acids; Drug Combinations; Gentamicins; Humans; Male; Mefenamic Acid; Sacroiliac Joint; Salmonella; Salmonella Infections; Sulfamethoxazole; Tomography, X-Ray Computed; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Age Factors; Amoxicillin; Drug Combinations; Humans; Infant; Infant, Newborn; Middle Ear Ventilation; Otitis Media; Otitis Media with Effusion; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The incidence of drug-induced skin rashes and related factors were analysed in a retrospective study of 151 patients with acute non-lymphocytic leukaemia (ANLL). 91 (60%) developed a drug-related toxicodermia to one or more drugs during remission, induction and maintenance therapy. The incidence of rashes was mainly confined to the blastic stage of leukaemia and occurred significantly less often during remission. Patients with acute myeloid leukaemia, FAB classification M1, M2 and M3 (M1-3) developed skin reactions more often than those of types M4 and M5 (M4-5). Women suffered more frequently from drug-induced skin lesions than men. The incidence of drug-associated rashes was significantly higher in patients with ANLL than in the general population for: Allopurinol (16%), co-trimoxazole (14%), miconazole (28%), and ketoconazole (18%). The incidence for the penicillins (12%) and cephalosporins (3%) conformed to the upper limit as reported for the general population. Additional toxic effects of combined therapy could not explain the differences observed and a dearrangement of the immunesystem during the blastic stage of leukaemia is suggested.

Topics: Acute Disease; Adult; Allopurinol; Cephalosporins; Drug Combinations; Drug Eruptions; Female; Humans; Ketoconazole; Leukemia; Male; Miconazole; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In January, February and March 1987, the frequency of Group A beta hemolytic streptococcus among 468 patients with acute tonsillopharyngitis who admitted to Dr. Sami Ulus Children's Hospital was % 41. Ten day procaine penicillin therapy was not successful in the % 29.5 patients. Cefadroxil (Duricef), clavulanic acid-amoxicillin combination (Augmentin) and erythromycin were tried in these patients. While the success rate of Duricef therapy was % 55, the results of other drug therapies were not been successful.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Cefadroxil; Child; Child, Preschool; Drug Combinations; Erythromycin; Female; Humans; Male; Penicillin G Procaine; Penicillin Resistance; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Sulfamethoxazole; Tonsillitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Amoxicillin; Anti-Infective Agents, Urinary; Drug Combinations; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adolescent; Adult; Aged; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Prospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Single-dose therapy for selected genitourinary tract infections is an effective alternative to multiple-dose regimens. Candidal vulvovaginitis and trichomonal vaginitis may be routinely treated with single-dose regimens. With acute cystitis, candidates for single-dose therapy include patients who have a short duration of symptoms and are likely to comply with follow-up.

Topics: Acute Disease; Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Vulvovaginal; Cystitis; Drug Administration Schedule; Drug Combinations; Female; Gardnerella vaginalis; Haemophilus Infections; Humans; Infections; Metronidazole; Sulfamethoxazole; Trichomonas Vaginitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vaginal Diseases

Topics: Acute Disease; Adult; Amylases; Brain Abscess; Drug Combinations; Humans; Male; Nocardia asteroides; Nocardia Infections; Pancreatitis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

6 out of 7 patients with severe neutropenia associated with the use of amodiaquine for malaria prophylaxis amodiaquine (400 mg weekly) plus proguanil (200 mg daily); 1 of these patients had also taken cotrimoxazole and another had taken sulphaguanidine. The 7th patient had taken amodiaquine alone, but at a higher dose. A retrospective analysis suggests that the frequency of severe neutropenia complicating amodiaquine taken prophylactically may be as high as 1 in 2000.

Topics: Acute Disease; Adult; Agranulocytosis; Amodiaquine; Drug Combinations; Drug Therapy, Combination; Female; Humans; Leukocyte Count; Malaria; Male; Middle Aged; Neutropenia; Proguanil; Retrospective Studies; Sulfaguanidine; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The penetrance of mezlocillin, metronidazole and trimethoprim-sulfamethoxazole into the pancreatic juice of humans was measured in ten patients convalescing from acute pancreatitis at the time of endoscopic retrograde cholangiopancreatography. Therapeutic levels were obtained in the serum for all three antimicrobial agents; simultaneously aspirated nonbile stained pancreatic juice contained therapeutic levels of metronidazole and trimethoprim-sulfamethoxazole. Mezlocillin was not present in a therapeutic level in any patient with nonbile stained pancreatic fluid.

Topics: Acute Disease; Cholangiopancreatography, Endoscopic Retrograde; Chromatography, High Pressure Liquid; Drug Combinations; Drug Evaluation; Humans; Metronidazole; Mezlocillin; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Juice; Pancreatic Pseudocyst; Pancreatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 55-year-old man became acutely psychotic and had a pseudoseizure after receiving six doses of intravenously administered trimethoprim-sulfamethoxazole. These symptoms resolved within 24 hours after discontinuation of the medication; this finding suggests a causal effect of the drug administration.

Topics: Acute Disease; Anti-Infective Agents; Drug Combinations; Humans; Infusions, Parenteral; Male; Middle Aged; Psychoses, Substance-Induced; Seizures; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

An acute pneumonic process in an immunosuppressed child poses a diagnostic and therapeutic challenge. These patients tolerate infection poorly. An open lung biopsy may provide prompt diagnosis. Nevertheless, a beneficial change in therapy that results in survival does not necessarily follow. Fifty-six immunosuppressed children with acute respiratory symptoms and interstitial pulmonary infiltrates underwent lung biopsy from 1974 to 1985. The most common underlying diagnosis was acute lymphocytic leukemia (60%). A specific etiology was determined in 46 (82%). Operative morbidity in 52% included prolonged intubation, recurrent pneumothorax, and hemorrhage. Overall, mortality was 34%. Those patients with solid tumor and those who required postoperative ventilation had a statistically significant higher mortality than all others. We defined biopsy "patient benefit" as follows: (1) the biopsy yielded an etiology for which a change of treatment was required; and (2) the child survived this acute illness. Despite the successful diagnostic results of this procedure, only 13 (23%) of the patients derived clinical benefit. Even though a specific infectious etiology was diagnosed in 39 (69%) patients only ten (18%) of these improved and survived after an appropriate change in therapy. Eight of these had Pneumocystis carinii. One survivor benefited from the treatment of documented radiation pneumonitis. Another was successfully treated for graft v host reaction but this diagnosis also was made by skin biopsy. One half of the biopsies were performed very early in the course of the illness, specifically to exclude Pneumocystis carinii of which we saw a peak incidence in 1978 to 1979.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adolescent; Adult; Biopsy; Child; Child, Preschool; Diagnosis, Differential; Drug Combinations; Emergencies; Humans; Immune Tolerance; Infant; Leukemia, Lymphoid; Lung; Lung Diseases, Fungal; Pneumonia, Pneumocystis; Prognosis; Pulmonary Fibrosis; Retrospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Acute monosymptomatic aseptic meningitis was observed in a 4 year old male patient. Toxoplasma gondii tachyzoites were detected in Giemsa-stained smears prepared from the CSF. Inoculation of mice gave the same result. The patient was cured after the application of pyrimethamine and sulpha drugs. On basis of the smears, the serological results and data in the literature, a direct infection through the nasal cavity has been assumed.

Topics: Acute Disease; Child, Preschool; Drug Combinations; Folic Acid; Humans; Male; Meningitis; Meningitis, Aseptic; Pyrimethamine; Staining and Labeling; Sulfamethoxazole; Toxoplasmosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Amphotericin B; Bacterial Infections; Digestive System; Drug Combinations; Humans; Leukemia; Leukocyte Count; Neomycin; Polymyxin B; Polymyxins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Acute Kidney Injury; Adult; Brucellosis; Doxycycline; Drug Combinations; Humans; Male; Rhabdomyolysis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Aminoglycosides; Anti-Bacterial Agents; Bacteriuria; Cystitis; Drug Combinations; Female; Fetus; Folic Acid; Humans; Male; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis; Recurrence; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adult; Bacteriuria; Diagnosis, Differential; Drug Combinations; Enterobacteriaceae Infections; Humans; Lymphogranuloma Venereum; Male; Nitrofurantoin; Pain; Pain Management; Prostatectomy; Prostatic Diseases; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Nine episodes of drug associated acute interstitial nephritis, in seven patients, were treated between 1972 and 1980. The drugs implicated were cotrimoxazole (three times), ampicillin, Magnapen (ampicillin and flucloxacillin), penicillin, gentamicin, paracetamol and bendrofluazide. The time from exposure to the onset of symptoms ranged from one to 30 days. Presentation was with acute renal failure, which was non-oliguric in five cases, accompanied by rash (four), fever (four), and loin pain (two). Renal biopsy was carried out in all cases, and showed a characteristic interstitial infiltrate comprising substantial numbers of lymphocytes and plasma cells, with a variable number of neutrophils, eosinophils and histiocytes. Immunofluorescence was negative in all four cases studied in the acute phase, and showed scattered deposits of IgG, IgM, IgA and C3 on the tubular basement membrane in one patient during recovery. Significant proteinuria and an abnormal urine deposit were present in all cases, and seven of nine had radiological evidence of enlarged kidneys. Seven episodes were treated with high doses of methyl prednisolone and in all there was a response with a diuresis or spontaneous fall in serum creatinine within 72 hrs, and recovery of virtually normal renal function. Of two cases who did not initially receive steroids, one improved more slowly and one developed chronic renal impairment.

Topics: Acetaminophen; Acute Disease; Adult; Ampicillin; Anti-Infective Agents, Urinary; Bendroflumethiazide; Drug Combinations; Female; Floxacillin; Gentamicins; Humans; Kidney; Male; Methylprednisolone; Middle Aged; Nephritis, Interstitial; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

An open comparative study was carried out in 56 paediatric patients with acute upper and lower respiratory tract infections to assess the efficacy and tolerance of treatment with erythromycin, amoxicillin or co-trimoxazole. Patients were treated with the standard recommended doses for 7 to 10 days. Diagnoses included otitis, tonsillitis, pharyngitis, epiglottiditis, pertussis, scarlet fever and bronchitis and, when possible, pathogens were isolated and identified at the initial visit. The clinical findings showed that all three treatment resulted in statistically significant decreases in final mean values for temperature, pulse rate and respiration rate. Twenty of the patients with positive cultures on entry became negative by the end of treatment. No clinical side-effects, were reported with any of the treatments. Overall assessment of response and acceptability of treatment by physician and patient/parent indicated that erythromycin was at least equally as effective as the other two drugs in treating common respiratory diseases found in paediatric practice.

Topics: Acute Disease; Amoxicillin; Body Temperature; Child; Child, Preschool; Drug Combinations; Erythromycin; Female; Humans; Male; Pulse; Respiration; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The amikacin-carbenicillin-cotrimoxazole combination was used as an empiric treatment for febrile episodes in patients with acute leukemia and severe granulocytopenia. The choice of drugs was based on the finding in our institute that the majority of infections are caused by gram-negative rods, particularly Pseudomonas, with high percentage of strains resistant to gentamycin and tobramycin. Granulocyte transfusions were given to the patients who did not show satisfactory clinical improvement 48 h after start of antibiotic therapy. There were cures in 84.6% of the febrile episodes treated with this antibiotic combination, including five of eight episodes of microbiologically confirmed bacteremia. Survival after 21 days of antibiotic therapy amounted to 89.1%. Renal toxicity occurred in 10.9% of the episodes treated. The prompt use of this antibiotic combination seems to be a safe and efficacious therapeutic tool for treating these high-risk patients.

Topics: Acute Disease; Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Anti-Bacterial Agents; Bacterial Infections; Carbenicillin; Drug Combinations; Drug Therapy, Combination; Female; Humans; Leukemia; Male; Middle Aged; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Animals; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Female; Humans; Male; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Drug Combinations; Follow-Up Studies; Humans; Penicillins; Pneumonia; Streptomycin; Sulfamethoxazole; Sulfanilamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination