trimethoprim--sulfamethoxazole-drug-combination and Chronic-Disease

Mycetoma are chronic subcutaneous infections, endemic in dry tropical regions. It can be caused either by actinomycetes or by fungi, presenting as filamentous grains in vivo. The foot is the most common localization. The main complication is osseous involvement. Patients are rural workers living in areas situated far from medical centers. Too often, they reach well-equipped hospitals with advanced mutilating lesions. Early case detection is the first condition for good therapeutic results. Clinical presentations of actinomycetoma and eumycetoma are similar, only biological diagnosis can distinguish the two etiological forms. This distinction is essential as medical therapy for each is radically different. Precise identification of the causal agent is required for targeted treatment but it can only be realized in rare specialized laboratories. For actinomycetoma, standard therapy is trimethoprim-sulphamethoxazole (STX). Duration of treatment period is one-year minimum. In case of poor response to STX or high risk of dissemination, a combination with amikacin gave high cure rate. Other options as amoxicillin-clavulanate are available. Medical cure of actinomycetoma is generally obtained with antibiotic treatments and surgical indications are exceptional. Disappointing results were observed using antifungal in the treatment of eumycetoma and medical therapy must be completed with surgical excision. Itraconazole is now the most used drug, new triazoles are on evaluation.

Topics: Actinobacteria; Antifungal Agents; Chronic Disease; Humans; Itraconazole; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Q fever may be present as an acute or a chronic infection and can be reactivated during subsequent pregnancies. Although its exact prevalence remains unknown, it is likely that the number of cases of Q fever in pregnant women is underestimated. During pregnancy, the illness is likely to be asymptomatic, and diagnosis is based on serology. Acute infection results in appearance of IgM and IgG antibodies mainly directed against the avirulent form of C. burnetii (phase II). Chronic Q fever results in particularly high level of IgG and IgA antibodies directed against both virulent (phase I) and avirulent (phase II) forms of the bacterium. Q fever may result in adverse pregnancy outcome, including spontaneous abortion, intrauterine growth retardation, oligoamnios, intrauterine fetal death (IUFD), and premature delivery. Obstetric complications occur significantly more often as C. burnetii infects the patient at an early stage of her pregnancy. Occurrence of IUFD is correlated with the presence of placental infection by C. burnetii and might be the consequence of direct infection of the fetus. The mother is exposed to the risk of chronic Q fever and endocarditis with potential fatal evolution. Long-term cotrimoxazole therapy prevents from placental infection, IUFD, and maternal chronic Q fever. Such treatment should be used to treat pregnant women with Q fever. Women with previous history of Q fever should have a regular serological follow up. Obstetricians' knowledge about Q fever must be improved.

Topics: Animals; Antibodies, Bacterial; Chronic Disease; Coxiella burnetii; Delivery, Obstetric; Female; Fetus; Humans; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Q Fever; Serologic Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Topics: Anti-Bacterial Agents; Chronic Disease; Clindamycin; Community-Acquired Infections; Cross Infection; Diagnosis, Differential; Drainage; Humans; Methicillin Resistance; Patient Education as Topic; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Antimicrobial therapy is the standard of care for the unusual man with true chronic bacterial prostatitis but does not have much of a role in the treatment of men with nonbacterial prostatitis. The fluoroquinolone antibiotics given for 2 to 4 weeks will cure about 70% of chronic bacterial infections of the prostate. If this treatment fails, the symptomatic manifestations of the infections can almost always be eliminated with suppressive antimicrobial therapy using trimethoprim-sulfamethoxazole, a fluoroquinolone antibiotic, or nitrofurantoin.

Topics: Anti-Infective Agents; Bacterial Infections; Chronic Disease; Fluoroquinolones; Humans; Male; Nitrofurantoin; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urine

Wegener's granulomatosis (WG) is a rare disease among paediatric patients. Chronic otitis media with or without facial nerve dysfunction is a known manifestation of the disease among adults. A case of a 15-year-old boy with WG, whose initial symptoms were acute otitis media and facial nerve paralysis, is presented. The otorhinolaryngological manifestations, as well as diagnostic and current treatment modalities in paediatric patients with WG, are discussed.

Topics: Administration, Oral; Adolescent; Adult; Anti-Infective Agents, Urinary; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Biopsy; Chronic Disease; Cyclophosphamide; Diagnosis, Differential; Drug Therapy, Combination; Ear, Middle; Facial Nerve; Facial Paralysis; Granulomatosis with Polyangiitis; Humans; Injections, Intravenous; Male; Otitis Media; Prednisone; Severity of Illness Index; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Turbinates

Chronic osteomyelitis has been a difficult problem for patients and the treating physicians. Appropriate antibiotic therapy is necessary to arrest osteomyelitis along with adequate surgical therapy. Factors involved in choosing the appropriate antibiotic(s) include infection type, infecting organism, sensitivity results, host factors, and antibiotic characteristics. Initially, antibiotics are chosen on the basis of the organisms that are suspected to be causing the infection. Once the infecting organism(s) is isolated and sensitivities are established, the initial antibiotic(s) may be modified. In selecting specific antibiotics for the treatment of osteomyelitis, the type of infection, current hospital sensitivity resistance patterns, and the risk of adverse reactions must be strongly appraised. Antibiotic classes used in the treatment of osteomyelitis include penicillins, beta-lactamase inhibitors, cephalosporins, other beta-lactams (aztreonam and imipenem), vancomycin, clindamycin, rifampin, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, metronidazole, and new investigational agents including teicoplanin, quinupristin/dalfopristin, and oxazolidinones. Traditional treatments have used operative procedures followed by 4 to 6 weeks of parenteral antibiotics. Adjunctive therapy for treating chronic osteomyelitis may be achieved by using beads, spacers, or coated implants to deliver local antibiotic therapy and/or by using hyperbaric oxygen therapy (once per day for 90-120 minutes at two to three atmospheres at 100% oxygen).

Topics: Anti-Infective Agents; beta-Lactamase Inhibitors; Cephalosporins; Chronic Disease; Drug Resistance, Microbial; Humans; Hyperbaric Oxygenation; Microbial Sensitivity Tests; Osteomyelitis; Penicillins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Chronic Disease; Drug Therapy, Combination; Fluoroquinolones; Gram-Negative Bacterial Infections; Humans; Osteomyelitis; Rifampin; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

Both linezolid and cotrimoxazole are antibiotics that are well suited for oral therapy of bone and joint infections (BJI) caused by otherwise resistant Gram-positive cocci (GPC) (resistance to fluoroquinolones, maccolides, betalactamines). However, in this context, no data are currently available regarding the safety and tolerance of these antibiotics in combination with rifampicin. The objective of this study was to compare the efficacy and safety of a combination of rifampicin and linezolid (RLC) with those of a combination of rifampicin and cotrimoxazole (RCC) in the treatment of BJI. Between February 2002 and December 2006, 56 adult patients (RLC, n = 28; RCC, n = 28), including 36 with infected orthopaedic devices (RLC, n = 18; RCC, n = 18) and 20 with chronic osteomyelitis (RLC, n = 10; RCC, n = 10), were found to be eligible for inclusion in this study. Patients who discontinued antibiotic therapy within 4 weeks of commencing treatment were considered to represent cases of treatment failure and were excluded. Rates of occurrence of adverse effects were similar in the two groups, at 42.9% in the RLC group and 46.4% in the RCC group (p = 1.00), and led to treatment discontinuation in four (14.3%) RLC and six (21.4%) RCC patients. Cure rates were found to be similar in the two groups (RLC, 89.3%, RCC, 78.6%; p = 0.47). Prolonged oral RLC and RCC therapy were found to be equally effective in treating patients with BJI caused by resistant GPC, including patients with infected orthopaedic devices. However, the lower cost of cotrimoxazole compared with linezolid renders RCC an attractive treatment alternative to RLC. Further larger clinical studies are warranted to confirm these preliminary results.

Topics: Acetamides; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chronic Disease; Drug Therapy, Combination; Female; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Linezolid; Male; Middle Aged; Orthotic Devices; Osteomyelitis; Oxazolidinones; Prosthesis-Related Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To study the cost-effectiveness of a 6- to 12-week course of high-dose oral trimethoprim-sulfamethoxazole in children with chronic active otitis media (COM).. Cost-effectiveness study including both direct and indirect costs alongside a randomized placebo-controlled trial.. Tertiary care university hospital in the Netherlands.. One hundred one children aged 1 to 12 years with a documented history of COM for at least 3 months.. Six to 12 weeks of oral trimethoprim-sulfamethoxazole 18 mg/kg twice daily versus placebo.. Incremental cost-effectiveness in terms of costs per number needed to treat (NNT) to cure 1 patient (incremental cost-effectiveness ratio [ICER]). Curation was defined as no otomicroscopic signs of otorrhea in either ear.. After 6 weeks of follow-up, the difference in mean cost per patient between the trimethoprim-sulfamethoxazole and placebo groups was Euro100 (US $126). The NNT was 4 (clinical effect), and the corresponding ICER was Euro400 (US $504), that is, the average extra costs to cure 1 child from otorrhea is Euro400 (US $504). After 12 weeks of follow-up, the difference in mean costs between both groups was Euro159 (US $201), the NNT was 7, and the corresponding ICER was Euro1,113 (US $1,407).The mean costs after 1 year of follow-up were Euro1,601 (US $2,021) in the trimethoprim-sulfamethoxazole group and Euro1,164 (US $1,469) in the placebo group. Because the clinical effect of trimethoprim-sulfamethoxazole disappeared after its discontinuation, we did not calculate an ICER at 1 year of follow-up.. In children with active COM, direct and indirect costs of a 6- to 12-week course of high-dose oral trimethoprim-sulfamethoxazole are modest in the light of its short-term clinical benefit.

Topics: Anti-Infective Agents; Child; Child, Preschool; Chronic Disease; Cost-Benefit Analysis; Follow-Up Studies; Hospitals, University; Humans; Infant; Netherlands; Otitis Media; Placebos; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The goal was to determine the clinical effectiveness of prolonged outpatient treatment with trimethoprim/sulfamethoxazole for children with chronic active otitis media.. We performed a randomized, placebo-controlled trial with 101 children (1-12 years of age) with chronic active otitis media (defined as otorrhea for > or =12 weeks). In addition to a short course of steroid and antibiotic eardrops, children were assigned randomly to receive 6 to 12 weeks of orally administered trimethoprim/sulfamethoxazole (18 mg/kg, 2 times per day) or placebo and were monitored for 1 year.. At 6 weeks, 28% of children in the trimethoprim/sulfamethoxazole group and 53% of children in the placebo group had otomicroscopic signs of otorrhea. At 12 weeks, these values were 32% and 47%, respectively. At 1 year, the numbers of children with otorrhea were similar in the 2 groups (25% and 20%, respectively). One child in the trimethoprim/sulfamethoxazole group developed a skin rash. Vomiting or diarrhea was reported for 9% of the trimethoprim/sulfamethoxazole group and 2% of the placebo group. Pure-tone hearing levels and health-related quality of life improved during the study but did not differ between the trimethoprim/sulfamethoxazole group and the placebo group. Pseudomonas aeruginosa was the most frequently isolated bacteria in the otorrhea samples from both groups.. A 6- to 12-week course of high-dose, orally administered trimethoprim/sulfamethoxazole therapy is beneficial for children with chronic active otitis media. The treatment effect is most pronounced with the shorter course and disappears if administration of the medication is discontinued.

Topics: Child; Child, Preschool; Chronic Disease; Female; Follow-Up Studies; Humans; Infant; Male; Otitis Media; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

of this study was to comprise the efficacy of chronic therapy with nitrofuarntoin in the treatment and prevention of recurrent urinary tract infections (NIM) in type 2 diabetic women.. The study comprised 105 women aged 50-70 years, who suffered from the NIM (isolated bacterial uropathogen sensitive to nitrofurantoin and cotrimoxazole). Women were divided into two groups. Group 1 (n=55) consisted of patients, who have been treated with nitrofurantoin and group 2 - control group (n=50) with cotromixazole. Observation period lasted 12 months and for the 9 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved.. There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after three, six and nine months of the antimicrobial treatment (NS). Three months after discontinuation of this treatment episodes of NIM were observed in similar frequency in two study groups (NS).. Nitrofurantoin is the effective antimicrobial method to cure and prevent NIM.

Topics: Aged; Anti-Infective Agents, Urinary; Chronic Disease; Diabetes Mellitus, Type 2; Escherichia coli; Female; Humans; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In developing countries, Isospora belli and Cyclospora cayetanensis frequently cause chronic diarrhea in HIV-infected patients.. To compare 1 week of trimethoprim-sulfamethoxazole treatment and 1 week of ciprofloxacin treatment in HIV-infected patients with chronic diarrhea caused by I. belli and C. cayetanensis.. Randomized, controlled trial.. HIV clinic in Port-au-Prince, Haiti.. 42 HIV-infected patients with chronic diarrhea due to I. belli (n = 22) or C cayetanensis (n = 20).. Patients were randomly assigned to receive oral trimethoprim-sulfamethoxazole (160 mg or 800 mg) or ciprofloxacin (500 mg) twice daily for 7 days. Patients who responded clinically and microbiologically received prophylaxis for 10 weeks (1 tablet orally, three times per week).. Treatment success was measured by cessation of diarrhea and negative stool examination at day 7. Prophylaxis success was measured by recurrent disease rate.. Diarrhea ceased in all 19 patients treated with trimethoprim-sulfamethoxazole. Eighteen of 19 patients had negative results on stool examination at day 7 (95%). Among the 23 patients who received ciprofloxacin, diarrhea ceased in 20 (87% [CI; 66% to 97%]) and 16 had negative results on stool examination at day 7 (70%). By survival analysis, diarrhea from isosporiasis and cyclosporiasis ceased more rapidly with trimethoprim-sulfamethoxazole than with ciprofloxacin. All patients receiving secondary prophylaxis with trimethoprim-sulfamethoxazole remained disease-free, and 15 of 16 patients receiving secondary prophylaxis with ciprofloxacin remained disease-free.. A 1-week course of trimethoprim-sulfamethoxazole is effective in HIV-infected patients with cyclosporiasis or isosporiasis. Although ciprofloxacin is not as effective, it is acceptable for patients who cannot tolerate trimethoprim-sulfamethoxazole.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Animals; Anti-Infective Agents; Chronic Disease; Ciprofloxacin; Coccidiosis; Diarrhea; Drug Administration Schedule; Eucoccidiida; Humans; Isospora; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

This prospective study was conducted to determine the spectrum of micro-organisms encountered in patients with active-stage chronic suppurative otitis media (CSOM) (tubotympanic type) and to see whether prescribing an antibiotic after culture sensitivity was more beneficial as compared to initial treatment without cultures.. Prospective randomized study of 110 patients of active CSOM (tubotympanic type) divided into two groups of 55 cases each.. Departments of Ear, Nose and Throat and Microbiology of a tertiary care hospital.. The patients in group A were prescribed an antibiotic according to the culture and sensitivity, whereas in group B, culture was not done at the first visit, and a broad-spectrum antimicrobial, namely, co-trimoxazole, was prescribed blindly for a maximum period of 2 weeks. The cases that still had ear discharge were then subjected to culture and sensitivity and the antibiotic was prescribed accordingly.. All patients in group A were subjected to bacterial culture and sensitivity and fungal culture. Only failed cases in group B were subjected to the same.. In group A, 47 patients (85.50%) had positive bacterial culture and 20 patients had positive fungal culture. Pseudomonas aeruginosa was the most common bacterial isolate. All of these 47 patients had a dry ear with a maximum 2 weeks of antibiotic therapy. Among the remaining 8 patients who had negative bacterial culture, 5 patients (9.0%) showed fungal isolates on culture and responded to topical antifungal treatment. The remaining 3 failed cases (5.5%) responded to daily dry mopping alone. In group B, 41 patients (74.54%) attained a dry ear. Bacterial culture and sensitivity were done in the remaining 14 (25.46%) failed cases. The culture was positive in 11 patients (20.0%) and sterile in 3 patients (5.5%). In the latter group, only 1 patient had fungus on culture and the remaining 2 patients responded to daily dry mopping alone, which was done at a maximum for a week only. The most common fungal pathogen isolated was Aspergillus flavus.. Pseudomonas aeruginosa was the most common bacteria and Aspergillus flavus the most common fungus isolated in this study. In group A patients, the failed cases were less as compared to the control group B, but the p value was .2. Hence, there is no definite role of culture and sensitivity in the initial management plan of all cases of CSOM. Ideally, every such case should be prescribed a broad-spectrum antibiotic and only in failed cases should culture and sensitivity be done.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Child; Child, Preschool; Chronic Disease; Double-Blind Method; Ear, Inner; Female; Humans; Infant; Male; Middle Aged; Otitis Media, Suppurative; Prospective Studies; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Tympanic Membrane

Suppressive therapy with antibiotics has long been thought to decrease the number of complications from the neuropathic bladder in spinal cord injury patients, but it may also induce resistance to antibiotics which subsequently causes difficulties in treating symptomatic urinary tract infections. Forty-three chronic spinal cord injury patients were randomized to continue to receive daily trimethoprim-sulfamethoxazole (TMP-SMX) urinary tract prophylaxis versus discontinuing antibiotic prophylaxis. Patients were all at least 6 months after spinal cord injury. Patients were followed for a minimum of 3 months, with weekly catheter urine cultures. The difference in the colonization rate at onset and after 3 months (percent of cultures with asymptomatic bacteriuria) between the control and prophylaxis group was not statistically significant (P > 0.1). There was a significant decrease in the percentage of TMP-SMX resistant asymptomatic bacteriuria in the control group, 78.8%, compared to 94.1% in the suppressive group (P < 0.05). There was no significant difference in the number of symptomatic urinary tract infections following the withdrawal of suppressive therapy between the control group, 0.035/week, and the prophylaxis group, 0.043/week (P > 0.5). There was a larger percentage of TMP-SMX resistant symptomatic urinary tract infections in the treated group, 42.5% versus 37.5% in the control group, but the difference was not significant (P > 0.5). Irrespective of the method of bladder management, suppressive therapy with TMP-SMX did not reduce the incidence of symptomatic bacteriuria and did increase the percentage of cultures resistant to TMP-SMX in asymptomatic patients.

Topics: Adult; Aged; Aged, 80 and over; Bacteriuria; Chronic Disease; Humans; Male; Middle Aged; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study was designed to determine the middle ear bacterial pathogens, the frequency of serum immunoglobulin deficiency and the efficacy of medical management in patients with chronic suppurative otitis media without cholesteatoma. This was an open noncomparative clinical trial performed at the National Children's Hospital, San Jose, Costa Rica, and included 186 patients older than 2 months of age with a confirmed diagnosis of chronic suppurative otitis media without cholesteatoma. Middle ear cultures and serum for immunoglobulin determinations were obtained on admission. The first 40 patients were treated only with ceftazidime and from patient 41 and up, if a Gram-positive organism was cultured, oxacillin was added to (for combined infection) or replaced ceftazidime. Parenteral antibiotics and suction twice daily were continued until three days after the middle ear became dry. Trimethropimsulfamethoxazole prophylaxis was administered during the follow-up period. Middle ear bacterial cultures were positive in 166 patients. Pseudomonas sp. (35.6%), enteric Gram-negative organisms (28.7%) and Gram-positive cocci (26%) were the most common organisms. Immunoglobulin determinations were below normal in 3 of 69 (4.3%) evaluable patients. Dryness of the ear was achieved in 174 patients (93.5%) including 130 of 139 patients treated with ceftazidime, 28 of 28 patients treated with oxacillin and 14 of 14 patients treated with ceftazidime and oxacillin. Recurrent otorrhea developed in 39 (23.4%) patients. Twice-daily canal aspiration and parenteral ceftazidime for Gram-negative organisms and/or oxacillin for Gram-positive bacteria for 3 days after dryness of the middle ear followed by prophylactic oral antimicrobials are effective for treatment of most chronic suppurative otitis media without cholesteatoma patients.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftazidime; Child; Child, Preschool; Cholesteatoma, Middle Ear; Chronic Disease; Costa Rica; Female; Humans; Immunoglobulins; Infant; Injections, Intravenous; Male; Otitis Media, Suppurative; Oxacillin; Recurrence; Suction; Trimethoprim, Sulfamethoxazole Drug Combination

Twenty-three stabilized chronic uremic patients with no active or recent infection were treated for 10 days with either cefodizime (5 x 2 g intravenously, n = 10) or cotrimoxazole (960 mg orally b.i.d., n = 8) in order to evaluate the effects on the depressed polymorphonuclear metabolic response to phagocytic challenge; a separate group of 5 patients received placebo. Ex vivo evaluation in whole blood of energy delivery to the phagocytosis-associated respiratory burst activity in response to latex and zymosan challenge was determined by measuring hexose-monophosphate shunt NAD(P)H-oxidase-related glycolytic activity. Cefodizime induced a statistically significant increase in the baseline-depressed glycolytic response for both latex and zymosan challenge, in contrast to cotrimoxazole and placebo. Depressed phagocytosis-related metabolic function in hemodialyzed patients was stimulated by cefodizime in recommended therapeutic doses but not by cotrimoxazole, the effect persisting for at least 2 weeks after the end of treatment.

Topics: Adult; Aged; Cefotaxime; Chronic Disease; Dose-Response Relationship, Drug; Energy Metabolism; Female; Glycolysis; Humans; Injections, Intravenous; Latex; Male; Middle Aged; NADH, NADPH Oxidoreductases; NADPH Oxidases; Neutrophils; Phagocytes; Phagocytosis; Renal Dialysis; Respiratory Burst; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia; Zymosan

This controlled prospective study was designed to identify predictors for postoperative otorrhea among 157 children with chronic otitis media with effusion undergoing myringotomy and tympanostomy tube placement (intubation). Ear canal disinfection with 70% alcohol or povidone-iodine did not significantly alter ear canal or middle ear effusion bacteriology, or the frequency of otorrhea during the first 7 days after surgery. However, the risk of otorrhea on the second postoperative day was significantly increased by the presence of a bacterial pathogen in the ear canal (relative risk, 2.4), or in the middle ear effusion (relative risk, 1.9), and the presence of inflamed middle ear mucosa at surgery (relative risk, 1.7) after controlling for age, preoperative antibiotics, and postoperative ototopical cortisporin treatment. The use of systemic antimicrobial treatment in children with inflamed middle ear mucosa at surgery or whose ear canal or middle ear effusion cultures are positive for bacterial pathogens might reduce the incidence of post-operative otorrhea in children undergoing intubation for chronic otitis media with effusion.

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Chronic Disease; Disinfection; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Ear Ventilation; Multivariate Analysis; Otitis Media with Effusion; Otitis Media, Suppurative; Postoperative Care; Prednisone; Preoperative Care; Prospective Studies; Regression Analysis; Trimethoprim, Sulfamethoxazole Drug Combination

In a double-blind study of 137 patients with exacerbation of chronic bronchitis and chronic obstructive lung disease, the efficacy and safety of ofloxacin was compared with that of trimethoprim-sulfamethoxazole (TMP/SMX). Both groups improved. The frequency of severe adverse reactions was highest in the TMP/SMX group, and 14.9% of the patients discontinued the treatment. In the ofloxacin group 6% had to stop the treatment. The failure rate was significantly lower in the ofloxacin-treated patients, 3.2% versus 13.8% in the TMP/SMX group. Ofloxacin was found to be an effective drug with few adverse reactions.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bronchitis; Chronic Disease; Double-Blind Method; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Ofloxacin; Trimethoprim, Sulfamethoxazole Drug Combination

There are various forms of medical treatment for otitis media with effusion (OME) in children. One of these is a four week course of an antibiotic. A trial was carried out comparing cotrimoxazole with amoxicillin-potassium clavulanate in 102 cases with 181 affected ears. In addition this trial used various procedures to increase and monitor compliance, and the results showed that the compliant cases did much better than the noncompliant cases and cotrimoxazole was more effective than amoxicillin-potassium clavulanate. When the ethnic groupings were analysed the compliance was lower for the Maori (24%) and Pacific Islander (29%) than the European (49%). The success rate for the compliant cases whose middle ear effusion resolved in one or both ears had a similar result with Maori (40%), Pacific Islander (60%) and European (71%) probably indicating an increased nonmeasured compliance in the latter.

Topics: Age Factors; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Chi-Square Distribution; Child; Child, Preschool; Chronic Disease; Clavulanic Acids; Drug Administration Schedule; Female; Humans; Infant; Male; New Zealand; Otitis Media with Effusion; Patient Compliance; 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

Fifty-three patients were enrolled and evaluable in a randomized, double-blinded controlled clinical trial comparing prednisone for 7 days plus trimethoprim-sulfamethoxazole (TMP/SMZ) for 30 days vs. TMP/SMZ alone in treating chronic middle ear effusion (MEE). Clearing of the effusion in both ears or in one when only one was involved was called complete resolution; clearing in one of two affected ears was called partial resolution. The outcomes 2 weeks after initiation of therapy of 26 patients initially treated with prednisone plus TMP/SMZ were complete resolution in 20, partial resolution in three, and unchanged in three. The outcomes in 27 patients initially treated with TMP/SMZ alone were complete resolution in eight, partial resolution in three, unchanged in 13 and development of acute otitis media in three (P less than 0.01 for complete resolution). Two weeks after initiation of therapy, patients with a MEE that failed to clear were crossed over to the alternative regimen. Overall 29 of 41 patients (71%) who received oral prednisone plus TMP/SMZ initially or after the crossover had complete resolution of their middle ear effusion at 2 weeks after starting prednisone and TMP/SMZ. Five of 35 (14%) patients treated with prednisone plus TMP/SMZ and one of six (17%) patients treated with TMP/SMZ alone who had complete resolution at 4 weeks required subsequent referrals for tympanostomy tubes. A course of prednisone for 7 days plus TMP/SMZ for 30 days with monthly follow-up should be considered in children with MEE persisting beyond 6-8 weeks before referral for tympanostomy tube placement.

Topics: Chronic Disease; Double-Blind Method; Drug Therapy, Combination; Humans; Infant; Middle Ear Ventilation; Otitis Media with Effusion; Prednisone; Prognosis; Trimethoprim, Sulfamethoxazole Drug Combination

A randomized, controlled clinical trial was conducted in 76 children to evaluate the efficacy of trimethoprim-sulfamethoxazole for 4 weeks, prednisone for 2 weeks and aluminum ibuprofen suspension for 2 weeks in resolving chronic otitis media with effusion which had persisted for more than 8 weeks. After 2 weeks of treatment resolution rates of chronic otitis media with effusion in the prednisone and trimethoprim-sulfamethoxazole groups were significantly greater than those in the control (no treatment) and ibuprofen groups. After 4 weeks the differences in resolution rates between the control, trimethoprim-sulfamethoxazole and prednisone groups became smaller. After 12 months of follow-up, differences in hearing sensitivity among study groups were not statistically significant, although 83% of patients had a 15-dB or greater hearing loss. Therefore short term antimicrobial and antiinflammatory treatment did not appear to have a long lasting effect on chronic middle ear inflammation.

Topics: Analysis of Variance; Child; Child, Preschool; Chronic Disease; Follow-Up Studies; Hearing Loss; Humans; Ibuprofen; Infant; Otitis Media with Effusion; Prednisone; Randomized Controlled Trials as Topic; Recurrence; Regression Analysis; Trimethoprim, Sulfamethoxazole Drug Combination

Fifteen children who fulfilled the criteria of chronic non-specific diarrhea of infancy were evaluated for intestinal bacterial overgrowth. In 10 of 11 successfully investigated children we found bacterial overgrowth of the small intestine by upper respiratory tract microflora. In 9 of 10 children (group I) treated with trimethoprim-sulfamethoxazole the diarrhea ceased immediately, whereas in all children in group II (n = 5; 3 children excluded because of growth of Yersinia enterocolitica) treated with low-lactose diet the diarrhea persisted (p = 0.004). The results indicate that bacterial overgrowth of the small intestine by upper respiratory tract microflora may be a cause of chronic non-specific diarrhea and that this diarrhea may be successfully treated with trimethoprim-sulfamethoxazole.

Topics: Anti-Bacterial Agents; Bacteria; Chronic Disease; Clinical Trials as Topic; Diarrhea, Infantile; Drug Combinations; Female; Humans; Infant; Intestine, Small; Male; Prospective Studies; Random Allocation; Respiratory System; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In a controlled blind study sputum of 84 patients suffering from chronic bronchitis was bacteriologically examined prior to treatment. Hereby resistance against azidocillin was exhibited by six of the pathogenic agents or the suspected ones; the bacteria in 18 samples of sputum showed resistance against co-trimoxazol. Azidocillin demonstrated, as opposed to co-trimoxazol, slight yet not significant advantages in the elimination of the agents. Azidocillin was, however, significantly superior to co-trimoxazol in the physicians total assessment, which included the clinical process as well as the components of the sputum. According to the results of our investigations, the treatment of chronic bronchitis can be started without examining the sputum. However, in patients showing exacerbation of chronic bronchitis with life-threatening complications, the sputum should be examined before medication is conducted. In such cases we recommend the treatment to be started immediately with an appropriate bactericide like azidocillin and to be continued till the result of the antibiogram is finally established.

Topics: Adult; Aged; Bacterial Infections; Bronchitis; Chronic Disease; Drug Combinations; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin G; Penicillin Resistance; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amoxicillin; Bronchitis; Chronic Disease; Drug Combinations; Erythromycin; Female; Hospitalization; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines.. This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan.. In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009).. Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.

Topics: Chronic Disease; Cross-Sectional Studies; Humans; Mycetoma; Sudan; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of the study was to analyze the risk factors for relapse in patients with acute bacterial prostatitis (ABP), focusing on the impact of different antibiotic regimens. We conducted an observational study of all patients diagnosed with ABP (irritative and/or obstructive urinary symptoms, temperature of >37.8°C, and the presence of bacteriuria in urine culture, in the absence of data suggesting pyelonephritis) from January 2017 to December 2018. The main outcome was relapse. We performed a multivariate analysis to identify the risk factors associated with relapse. A propensity score with inverse weighting was applied to attenuate antibiotic selection bias. We included 410 patients. The mean age was 68 years; 28.8% had diabetes mellitus, and 61.1% benign prostatic hyperplasia. The most common isolated bacteria were Escherichia coli (62.4%) and Klebsiella spp. (10%). The overall resistance rate was 39.5% to quinolones. The mortality rate was 1.2%, and the relapse rate was 6.3%. The only independent risk factor for relapse was inadequate antibiotic therapy (odds ratio [OR] 12.3; 95% confidence interval [95% CI], 3.5 to 43.1). When the antibiotic was modified according to the susceptibility pattern, the rates of relapse were 1.8% in those treated with ciprofloxacin, 3.6% with intravenous beta-lactam, 9.3% with co-trimoxazole, and 9.8% with oral (p.o.) beta-lactam (

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteriuria; beta-Lactams; Chronic Disease; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Prostatitis; Pyelonephritis; Quinolones; Recurrence; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Cystoisosporiasis is an intestinal infectious disease caused by a coccidian protozoa, Cystoisospora belli (C. belli). It can cause prolonged and refractory diarrhea most commonly in immunocompromised patients, while immunocompetent individuals usually exhibit no symptoms or self-limited diarrhea.. We herein report a case of chronic cystoisosporiasis in an immunocompetent patient. A 62-year-old man, who had been first diagnosed with cystoisosporiasis 15 years ago and had been treated with oral administration of trimethoprim-sulfamethoxazole (TMP-SMX), complained of persistent watery diarrhea. He was negative for anti-human immunodeficiency virus antibody and anti-human T-cell leukemia virus type 1 (HTLV-1) antibody.. Biopsy specimens from the duodenum revealed oocysts in the atrophic absorptive epithelium and protozoa were detected through stool examination, indicating the recurrence of cystoisosporiasis. Capsule endoscopy showed diffuse atrophic mucosa with white villi in the entire small intestine. We diagnosed him with chronic cystoisosporiasis that occurred in an immunocompetent adult.. Since oral administration of TMP-SMX and ciprofloxacin were ineffective, the intravenous administration of TMP-SMX was initiated.. Intravenous TMP-SMX exhibited a significant improvement.. This case indicates that even immunocompetent individuals may develop recurrent and refractory cystoisosporiasis. Furthermore, intravenous treatment of antibiotic agents should be considered when the impaired absorptive ability from the small intestine is suspected.

Topics: Administration, Intravenous; Administration, Oral; Antiprotozoal Agents; Capsule Endoscopy; Chronic Disease; Diarrhea; Humans; Immunocompetence; Intestinal Diseases, Parasitic; Isosporiasis; Male; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim/sulfamethoxazole has been suggested as a treatment option for chronic rhinosinusitis with purulence. This study aimed to assess the functional and endoscopic outcomes after a three-month course of low-dose trimethoprim/sulfamethoxazole.. A prospective study was performed, comprising patients referred to a tertiary care medical centre with a diagnosis of chronic rhinosinusitis with purulence. Trimethoprim/sulfamethoxazole was prescribed at 960 mg/day for three months. Sinonasal complaints and endoscopic findings were documented, and bacteriological data were compared.. Fifteen patients were included. Staphylococcus aureus was the most common bacterium cultured (86 per cent). Improvement in nasal function, as measured by the 22-item Sino-Nasal Outcome Test, was highly significant at three months (p < 0.0005). This improvement slightly decreased but remained significant at 6, 9 and 12 months. No side effects were noted. Endoscopic scores revealed similar and concordant improvements.. Long-term low-dose trimethoprim/sulfamethoxazole therapy seems to be a safe option for selected patients. Additional randomised multicentre studies remain necessary.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Cavity; Nasal Surgical Procedures; Prospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Time; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

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

This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF) of the Universidade Federal do Rio de Janeiro (UFRJ). The first case (mild form) was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally) for three months and, then, with half the dose for nine months; the second (moderate form), with itraconazole (200 mg per day, orally) for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.

Topics: Antifungal Agents; Chronic Disease; Humans; Itraconazole; Male; Middle Aged; Paracoccidioidomycosis; Sarcoidosis; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Chronic Disease; Cyclospora; Cyclosporiasis; Diarrhea; Female; Humans; Nepal; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis is a rare disease with polymorphic presentations. The epidemiology and clinical presentation could change with the increasing number of immunocompromised patients.. The medical records and microbiological data of patients affected by nocardiosis and treated at the university hospitals of Marseille between 2004 and 2014 were analyzed retrospectively.. The cases of 34 patients infected by Nocardia spp during this period were analyzed. The main underlying conditions were transplantation (n=15), malignancy (n=9), cystic fibrosis (n=4), and immune disease (n=3); no immunodeficiency condition was observed for three patients. No case of AIDS was observed. At diagnosis, 61.8% had received steroids for over 3 months. Four clinical presentations were identified, depending on the underlying condition: the disseminated form (50.0%) and the visceral isolated form (26.5%) in severely immunocompromised patients, the bronchial form (14.7%) in patients with chronic lung disease, and the cutaneous isolated form (8.8%) in immunocompetent patients. Nocardia farcinica was the main species identified (26.5%). Trimethoprim-sulfamethoxazole was prescribed in 68.0% of patients, and 38.0% underwent surgery. Mortality was 11.7%, and the patients who died had disseminated or visceral nocardiosis.. The clinical presentation and outcome of nocardiosis depend on the patient's initial immune status and underlying pulmonary condition. Severe forms were all iatrogenic, occurring after treatments altering the immune system.

Topics: Adult; Aged; Chronic Disease; Cystic Fibrosis; Female; France; History, 21st Century; Hospitals, University; Humans; Immunocompromised Host; Male; Medical Records; Middle Aged; Neoplasms; Nocardia; Nocardia Infections; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Cystoisosporiasis is an opportunistic infection seen more commonly in patients with acquired immunodeficiency syndrome. Although uncommon, Cystoisospora infection can occur in immunocompetent individuals but tend to be benign and self-limiting. Chronic infection however, has been described but diagnosis can often be challenging and requires a high clinical index of suspicion.. We present a case of delayed diagnosis of Cystoisospora belli (C. belli) in an immunocompetent 28-year-old refugee from Myanmar. She had a history of chronic diarrhea where exhaustive investigations over many years failed to reveal a diagnosis. Cystoisospora belli cysts were finally detected in stool 4 years after investigation commenced, and PCR testing on stored colon biopsies amplified a molecular product with 99 % sequence homology to C. belli. The patient improved promptly with trimethoprim-sulfamethoxazole treatment.. In the appropriate clinical context we suggest molecular testing for C. belli or an empirical therapeutic trial.

Topics: Acquired Immunodeficiency Syndrome; Adult; Chronic Disease; Coccidiosis; Feces; Female; Humans; Immunocompromised Host; Microscopy; Myanmar; Polymerase Chain Reaction; Refugees; Sarcocystidae; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (SXT) is a possible alternative for the treatment of community- and hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) due to the susceptibility of most MRSA strains to the drug. However, after long-term treatment with SXT, thymidine-dependent (TD) SXT-resistant small-colony variants (SCVs) emerge. In TD-SCVs, mutations of thymidylate synthase ([TS] thyA) occur. Until now, it has never been systematically investigated that SXT is triggering the induction and/or selection of TD-SCVs. In our study, we performed induction, reversion, and competition experiments in vitro and in vivo using a chronic mouse pneumonia model to determine the impact of SXT on the emergence of TD-SCVs. SCVs were characterized by light and transmission electron microscopy (TEM) and auxotrophism testing. Short-term exposure of S. aureus to SXT induced the TD-SCV phenotype in S. aureus SH1000, while selection of TD-SCVs with thyA mutations occurred after long-term exposure. In reversion experiments with clinical and laboratory TD-SCVs, all revertants carried compensating mutations at the initially identified mutation site. Competition experiments in vitro and in vivo revealed a survival and growth advantage of the ΔthyA mutant under low-thymidine availability and SXT exposure although this advantage was less profound in vivo. Our results show that SXT induces the TD-SCV phenotype after short-term exposure, while long-term exposure selects for thyA mutations, which provide an advantage for TD-SCVs under specified conditions. Thus, our results further an understanding of the dynamic processes occurring during SXT exposure with induction and selection of S. aureus TD-SCVs.

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; Chronic Disease; Disease Models, Animal; Drug Resistance, Bacterial; Gene Expression; Genetic Fitness; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred C57BL; Mutation; Pneumonia, Bacterial; Selection, Genetic; Staphylococcal Infections; Thymidine; Thymidylate Synthase; Trimethoprim, Sulfamethoxazole Drug Combination

Despite their widespread use, antibiotics have not been shown to improve chronic rhinosinusitis (CRS) outcomes. We aimed to determine whether culture-inappropriate postoperative antibiotic therapy was associated with less quality-of-life (QOL) improvement following functional endoscopic sinus surgery (FESS).. This retrospective cohort study recruited 376 adult CRS patients undergoing FESS between October 1, 2007 to December 31, 2011. Patient demographics, comorbidities and medications were collected at baseline. Trimethoprim-sulfamethoxazole and clindamycin were administered for 2 weeks postoperatively. The antibiotic appropriateness was determined based on bacterial resistance profile of organisms identified during intraoperative culture. The QOL outcome was defined as change of 22-item Sinonasal Outcome Test scores from preoperative visit to 1-month, 3-month, and 6-month post-FESS. Clinically significant difference was defined as at least 0.5 standard deviations (SD) of baseline QOL score in the reference group. Mixed-effects regression models were performed.. Seven percent of patients (n = 27) had culture-inappropriate antibiotic therapy, and additional 5% (n = 19) had culture-specific antibiotic adjustment. Compared to patients with culture-appropriate antibiotics, patients with culture-inappropriate antibiotics had significantly less improvement of QOL from baseline to postoperative 1-month and 3-month follow-up where the difference became clinically significant; patients with antibiotic adjustment had more QOL improvement from baseline to 1-month follow-up, but their QOL worsened at 3-month follow-up, and these changes were not clinically significant. However, all effects washed out at 6-month follow-up with no significant differences.. Culture-inappropriate postoperative antibiotic therapy decreased short-term QOL improvement to a clinically meaningful level after FESS. Culture guided selection of antibiotics may improve short-term FESS outcome.

Topics: Adult; Antibiotic Prophylaxis; Chronic Disease; Clindamycin; Cohort Studies; Drug Resistance, Bacterial; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Paranasal Sinuses; Postoperative Period; Quality of Life; Retrospective Studies; Rhinitis; Sinusitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To determine if patients with inactive chorioretinitis lesions who experience chronic toxoplasmic uveitis test PCR positive for Toxoplasma in their ocular fluids.. Two patients undergoing long-term anti-toxoplasmic treatment developed chronic uveitis and vitritis. They underwent therapeutic and diagnostic pars plana vitrectomy. Patient specimens were tested for toxoplasmosis by real-time PCR and nested PCR. Patient specimens were also tested for the presence of Toxoplasma antibodies that recognise allelic peptide motifs to determine parasite serotype.. Patients tested positive for Toxoplasma by real-time PCR at the B1 gene in the vitreous and aqueous humours of patient 1, but only the vitreous of patient 2. Patients were not parasitemic by real-time PCR in plasma and blood. During surgery, only old hyperpigmented toxoplasmic scars were observed; there was no sign of active retinitis. Multilocus PCR-DNA sequence genotyping at B1, NTS2 and SAG1 loci established that two different non-archetypal Toxoplasma strains had infected patients 1 and 2. A peptide-based serotyping ELISA confirmed the molecular findings.. No active lesions were observed, but both patients possessed sufficient parasite DNA in their vitreous to permit genotyping. Several hypotheses to explain the persistence of the vitritis and anterior uveitis in the absence of active retinitis are discussed.

Topics: Anti-Infective Agents; Antibodies, Protozoan; Antiprotozoal Agents; Chronic Disease; DNA, Protozoan; Enzyme-Linked Immunosorbent Assay; Female; Genotyping Techniques; Glucocorticoids; Humans; Male; Middle Aged; Prednisone; Real-Time Polymerase Chain Reaction; Retinitis; Serotyping; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis; Vitrectomy; Vitreous Body

Mycobacterium simiae is a slow-growing mycobacteria that in rare cases can cause chronic pulmonary infection. We report the first case of lung transplantation in a patient with active M simiae infection at the time of transplantation. A 56-year-old immunocompetent nonsmoking woman underwent bilateral lung transplantation for end-stage idiopathic bronchiectasis and chronic M simiae infection. The disease proved manageable on a regimen of clarithromycin, moxifloxacin, and cotrimoxazole with a successful outcome 1-year posttransplantation. There is increasing evidence that nontuberculous mycobacterium infection should no longer be an absolute contraindication for lung transplantation.

Topics: Anti-Bacterial Agents; Aza Compounds; Bronchiectasis; Chronic Disease; Clarithromycin; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Lung Transplantation; Middle Aged; Moxifloxacin; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Quinolines; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam.. Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term.. Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group.. Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Chronic Disease; Female; Humans; Macrolides; Male; Middle Aged; Rhinitis; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Pseudomonas aeruginosa isolates from cystic fibrosis (CF) patients undergo remarkable phenotypic divergence over time, including loss of pigmentation, hemolysis, motility, and quorum sensing and emergence of antibiotic hypersusceptibility and/or auxotrophism. With prolonged antibiotic treatment and steady decline in lung function in chronically infected patients, the divergent characteristics associated with CF isolates have traditionally been regarded as "adapted/unusual virulence," despite the degenerative nature of these adaptations. We examined the phenotypic and genotypic diversity in clonally related isogenic strains of P. aeruginosa from individual CF patients. Our observations support a novel model of intra-airway pseudomonal syntrophy and accompanying loss of virulence. A 2007 calendar year collection of CF P. aeruginosa isolates (n = 525) from 103 CF patients yielded in vitro MICs of sulfamethoxazole-trimethoprim (SMX-TMP, which typically has no activity against P. aeruginosa) ranging from 0.02 to >32 μg/ml (median, 1.5). Coisolation of clonally related SMX-TMP-susceptible and -resistant P. aeruginosa strains from the same host was common (57%), as were isogenic coisolates with mutations in efflux gene determinants (mexR, mexAB-oprM, and mexZ) and genes governing DNA mismatch repair (mutL and mutS). In this cohort, complete in vitro growth complementation between auxotrophic and prototrophic P. aeruginosa isogenic strains was evident and concurrent with the coding sequence mosaicism in resistance determinants. These observations suggest that syntrophic clonal strains evolve in situ in an organized colonial structure. We propose that P. aeruginosa adopts a multicellular lifestyle in CF patients due to host selection of an energetically favorable, less-virulent microbe restricted within and symbiotic with the airway over the host's lifetime.

Topics: Adaptation, Physiological; Anti-Bacterial Agents; Chronic Disease; Clone Cells; Cystic Fibrosis; Genes, Bacterial; Genetic Heterogeneity; Humans; Microbial Sensitivity Tests; Mosaicism; Mutation; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory System; Trimethoprim, Sulfamethoxazole Drug Combination

To examine the association between trimethoprim/sulfamethoxazole, other US Food and Drug Administration (FDA) C and D anti-infectives, and non anti-infective FDA C, D, and X drugs used during pregnancy with preterm birth and low birth weight.. We carried out a retrospective cohort study based on a 50% random sample of women who gave birth in the Canadian province of Saskatchewan from 1997 to 2000. The association between trimethoprim/sulfamethoxazole, other FDA C and D anti-infectives (fluconazole, clarithromycin, doxycycline, and tetracycline), and non anti-infective FDA C, D, and X drugs used during pregnancy with preterm birth and low birth weight was evaluated using multiple logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) as association measures.. A total of 17 939 women were included in the final analysis. Trimethoprim/sulfamethoxazole was associated with significantly increased risks for preterm birth (aOR 1.51, 95% CI 1.10, 2.08) and low birth weight (aOR 1.67, 95% CI 1.14, 2.46). Exposure to non anti-infective FDA category C, D and X drugs was also associated with increased risks for preterm birth (aOR 1.17, 95% CI 1.09, 1.31) and low birth weight (aOR 1.14, 95% CI 0.92, 1.42), but to a lesser degree. Other FDA C and D anti-infectives were not (statistically) significantly associated with increased risks for preterm birth (aOR 0.93, 95% CI 0.49, 1.77) or low birth weight (aOR 0.65, 95% CI 0.27, 1.60).. Among FDA C, D and X drugs, trimethoprim/sulfamethoxazole, a folic acid antagonist, has the strongest association with preterm birth and low birth weight.

Topics: Adult; Age Factors; Anti-Infective Agents; Chronic Disease; Cohort Studies; Confidence Intervals; Databases, Factual; Drug Prescriptions; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Logistic Models; Parity; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Retrospective Studies; Risk Factors; Saskatchewan; Socioeconomic Factors; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Food and Drug Administration; Young Adult

Mycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by fungi or fungus-like bacteria. The infection eventually spreads to bone resulting in significant morbidity. Rarely, viscera may be involved through contiguous spread. It is common in tropical countries like India, though disease is worldwide in distribution. A 22-year-old male patient, a farmer by occupation, presented with multiple discharging sinuses over the left chest wall, shoulder, upper arm, and adjacent neck of eight months duration. A diagnosis of actinomycetoma was made based on clinical and histopathological features as culture was negative for both fungus and bacteria. The patient was treated with a modified two-step regimen. It consisted of an intensive phase with intravenous gentamicin 80 mg 12th hourly and cotrimoxazole 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with oral cotrimoxazole and doxycycline 100 mg twice daily. Patient showed excellent response with healing of all sinuses after two months of therapy. Involvement of covered parts of the body such as chest wall and shoulders is common in actinomycetoma compared to eumycetoma. Early institution of long-term combination therapy with antimicrobials results in excellent outcome.

Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Chronic Disease; Doxycycline; Drug Therapy, Combination; Gentamicins; Humans; Infusions, Intravenous; Male; Mycetoma; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Isolated Whipple disease of the central nervous system is a rare occurrence. Migratory arthralgias and gastrointestinal problems, including malabsorption, abdominal pain, diarrhea, and weight loss, are common presenting symptoms.. For those patients with systemic signs and symptoms of Whipple disease, 6% to 43% will have clinically manifested CNS involvement that may include alterations in personality, ataxia, and dementia. We report our experience with a patient, who was successfully treated for Whipple disease 12 years prior to presentation and had a magnetic resonance image of the brain that revealed two solitary lesions resembling a tumor upon presentation.

Topics: Anti-Infective Agents; Brain Neoplasms; Chronic Disease; Consciousness Disorders; Diagnosis, Differential; Diagnostic Errors; Encephalitis; Headache; Humans; Hypothalamus; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Temporal Lobe; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

To investigate the microbial etiology of suppurative chronic otitis media (SCOM) in patients with complete cleft lip and palate and isolated cleft palate and to determine the sensitivity of isolated microorganisms to antibiotics by drug diffusion from impregnated discs in agar and the minimum inhibitory concentration of each drug to these microorganisms by drug dilution in agar.. Effusion samples of SCOM obtained from 40 patients with cleft lip and palate registered at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, at Bauru, Brazil, were bacteriologically analyzed by cultures. The isolated bacteria were submitted to an in vitro susceptibility test to clinically used drugs.. Positive cultures were obtained in 100% of studied cases. Among the 57 strains observed, the most frequent were Pseudomonas aeruginosa (35%), Staphylococcus aureus (15.5%), Enterococcus faecalis (14%), and Proteus mirabilis (12%). The frequency of Gram-negative bacilli (enterobacteriaceae and nonfermentative bacilli) was 67%. Pseudomonas aeruginosa presented the highest sensitivity to ciprofloxacin, and enterobacteriaceae exhibited the highest sensitivity to gentamicin. The strains of S. aureus and E. faecalis presented the highest sensitivity to imipenem and sulfamethoxazole/trimethoprim, respectively.. Patients with cleft lip and palate presenting with SCOM exhibited 100% positive cultures, with the highest frequency of Pseudomonas and enterobacteriaceae. With regard to the action of antibiotics, imipenem was effective against the four species of isolated microorganisms, followed by ciprofloxacin, which was effective against 75% of isolated species.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Cleft Lip; Cleft Palate; Drug Resistance, Bacterial; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Imipenem; Infant; Male; Middle Aged; Otitis Media, Suppurative; Proteus Infections; Proteus mirabilis; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

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

The use of 3,4-methylenedioxymethamphetamine (MDMA, known as "ecstasy"), a synthetic amphetamine and "club drug," has been associated with acute, transient urinary retention. We report a case of neurogenic bladder and chronic urinary retention associated with MDMA abuse.. A 21-year-old male presented to the emergency department (ED) because he had abdominal pain and difficulty urinating. He had experienced difficulty in initiating urination over the past 1.5 months, with periods of 24 to 36 hours between voids and large volumes of urine. The patient had a chronic pattern of MDMA use, taking 4 tablets/day for 3 months. Two weeks before coming to the ED, he had been admitted to an inpatient drug rehabilitation center. During the time since that admission, the patient had visited EDs repeatedly for insertion and removal of Foley catheters to relieve the urinary retention until he could be admitted to a urologic service. Cystometrogram was abnormal, finding no sensation of bladder fullness after instillation of 350 mL of saline and inability to generate a voluntary voiding pressure. Cystoscopy revealed no outlet obstruction. The findings were consistent with neurogenic bladder. The patient was given prescriptions for bethanecol and phenazopyridine, and told to continue a 10-day course of sulfamethoxazole/trimethoprim for urinary tract infection. He was discharged with a Foley catheter in place. Symptoms of urinary retention persisted at 1-year follow-up, despite self-catheterization and complete cessation of MDMA use.. Chronic MDMA use may lead to neurogenic bladder and chronic urinary retention.

Topics: Adult; Amphetamine-Related Disorders; Anti-Infective Agents, Urinary; Bethanechol; Central Nervous System Stimulants; Chronic Disease; Cystoscopy; Humans; Male; Muscarinic Agonists; N-Methyl-3,4-methylenedioxyamphetamine; Phenazopyridine; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Retention

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

Here, we report a case of tetanus who presented with five months of symptoms and signs suggesting the presence of unusual presentation of tetanus so called chronic tetanus. The available literature on this a typical presentation and difficulty in the diagnosis is briefly discussed.

Topics: Adult; Anti-Infective Agents; Anticonvulsants; Chlorpromazine; Chronic Disease; Diagnosis, Differential; Diazepam; Humans; Male; Otitis Media; Tetanus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Chronic Disease; Drug-Related Side Effects and Adverse Reactions; Humans; Purpura, Thrombocytopenic; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Child; Chronic Disease; Humans; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of chronic-contained rupture of an infected aneurysm of the abdominal aorta, from which Listeria monocytogenes was cultured. The diagnosis of rupture and retroperitoneal mass was made by computed tomography, whereas FDG -PET diagnosed vessel wall inflammation. The infectious nature only became apparent at surgery.

Topics: Aged; Ampicillin; Aneurysm, Infected; Anti-Bacterial Agents; Anti-Infective Agents; Aortic Aneurysm, Abdominal; Aortic Rupture; Chronic Disease; Female; Fluorodeoxyglucose F18; Humans; Listeriosis; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Chronic Disease; Combined Modality Therapy; Enterococcus; Folic Acid; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Prostatectomy; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.

Topics: Aged; Aged, 80 and over; Bacteriological Techniques; Chronic Disease; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Foot Ulcer; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Oxacillin; Penicillin Resistance; Pressure Ulcer; Radiodermatitis; Skin Diseases, Bacterial; Skin Ulcer; Staphylococcal Skin Infections; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Vancomycin Resistance; Varicose Ulcer; Wound Infection

Topics: Anti-Infective Agents; Arthritis; Chronic Disease; Diarrhea; Duodenum; Gastrointestinal Transit; Humans; Intestinal Mucosa; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Tremor; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Whipple Disease

Antibiotics are the mainstay for the treatment of men with bacterial prostatitis. Despite numerous treatment strategies involving various types, dosages and duration of antibiotics, no uniform standard has been widely adapted. Moreover, the economic burden of these therapies has been heretofore poorly described. The purpose of this study was to compare the cost effectiveness of various antibiotic treatment regimens for chronic bacterial prostatitis.. After reviewing the literature, we constructed a model that compared 90 days of double strength trimethoprim-sulfamethoxazole and 14, 28 and 60 days of ciprofloxacin 500 mg. Parameters examined included initial cure rates, relapse rates, total cure rates, pharmaceutical costs, and total cost of treatment. Using a spreadsheet Markov model, we applied cure rates and relapse rates to a hypothetical cohort of 100 men with culture positive chronic bacterial prostatitis. We then calculated cost of medications and total healthcare costs for the various drug regimens.. Twice daily ciprofloxacin @ 500 mg for 28 days proved to be the most cost effective treatment for chronic bacterial prostatitis. Yet, after sensitivity analysis, only twice daily ciprofloxacin @ 500 mg for 60 days demonstrated consistent benefit over trimethoprim-sulfamethoxazole but at a substantially increased cost.. Our model implies that ciprofloxacin 500 mg twice daily for 28 days appears to be the most cost effective treatment for chronic bacterial prostatitis. Given the limitations of this type of modeling, long term, prospective, comparative trials will provide the most definitive method of evaluating optimal therapy for chronic bacterial prostatitis.

Topics: Anti-Infective Agents; Bacterial Infections; Chronic Disease; Ciprofloxacin; Cost-Benefit Analysis; Drug Costs; Health Care Costs; Humans; Male; Markov Chains; Models, Economic; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of an HIV-infected woman, who presented with chronic and productive cough without sign of hypersensitivity (fever, cutaneous eruption, gastrointestinal disorders), while taking abacavir. All complementary exams being negative, the involvement of abacavir has been suspected. So the drug was stopped leading to a rapid disappearance of cough. It is the first report of chronic cough with abacavir apart of a context of hypersensitivity reaction.

Topics: Alkynes; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Benzoxazines; Chronic Disease; Cough; Cyclopropanes; Dideoxynucleosides; Female; HIV Infections; HIV Protease Inhibitors; Humans; Lamivudine; Middle Aged; Nelfinavir; Oxazines; Reverse Transcriptase Inhibitors; Rhinitis; Sputum; Stavudine; Trimethoprim, Sulfamethoxazole Drug Combination

Recurrent isosporiasis in an immunocompetent host is reported. The patient suffered from chronic intermittent diarrhea for over a decade. Multiple short-term administrations of trimethoprim-sulfamethoxazole followed by pyrimethamine, or albendazole combined with tinidazole could not control the relapses. However, treatment with pyrimethamine, 25 mg/d for 20 weeks, was successful.

Topics: Albendazole; Animals; Anti-Infective Agents; Antiprotozoal Agents; Chronic Disease; Drug Administration Schedule; Humans; Immunocompetence; Isospora; Isosporiasis; Male; Middle Aged; Pyrimethamine; Recurrence; Time Factors; Tinidazole; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of possible severe, life-threatening thrombocytopenia associated with trimethoprim/sulfamethoxazole (TMP/SMX) therapy.. A 54-year-old white woman received a 10-day course of TMP/SMX for treatment of chronic sinusitis. One day after finishing the course of TMP/SMX therapy, the presented to the emergency department because of the development of scattered petechiae on both hands and blood blisters in her mouth. On admission, her complete blood cell count results revealed a severely low platelet count of 2 x 10(3)/mm3. Other laboratory test results were normal, except for elevated blood glucose (nonfasting blood glucose). TMP/SMX was believed to be the most likely cause of thrombocytopenia. She was treated successfully with a transfusion of 2 units of platelets and oral prednisone. Her platelet count increased to 110 x 10(3)/mm3 4 days after discontinuation of TMP/SMX. She was discharged on hospital day 5. On follow-up (2 wk after hospital discharge), her platelet count was normal (351 x 10(3)/mm3).. TMP/SMX has been implicated as a cause of thrombocytopenia, which is defined as platelet count < 150 x 10(3)/mm3. Although it is uncommon, spontaneous severe bleeding may occur when platelet count decreases to < or = 10 x 10(3)/mm3. Thrombocytopenia associated with TMP/SMX appears to be an immune-mediated process resulting in platelet destruction by drug-dependent platelet antibodies. Treatment of thrombocytopenia associated with TMP/SMX therapy includes discontinuation of the offending drug and the use of corticosteroids. Platelet transfusion and intravenous immunoglobulin may be required in some patients.. Thrombocytopenia associated with TMP/SMX therapy can be serious or life threatening because it may result in significant bleeding complications. This hematologic adverse effect of TMP/SMX may occur even with the usual recommended dosage and duration of therapy. Careful monitoring of complete blood cell count, including platelet count, before and during TMP/SMX therapy is suggested.

Topics: Anti-Infective Agents; Blood Cell Count; Chronic Disease; Female; Humans; Middle Aged; Platelet Count; Sinusitis; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

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

Topics: Anti-Infective Agents; Bipolar Disorder; Chronic Disease; Clozapine; Drug Synergism; Female; Humans; Middle Aged; Neutropenia; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

Two horses with chronic empyema of the auditory tube diverticulum (guttural pouch) were refractory to medical treatment; empyema was bilateral in 1 horse and unilateral in the other. Both horses were treated by fistulation of the cartilage of the pharyngeal orifice by use of a neodymium:yttrium-aluminum-garnet laser in a noncontact manner. To maintain patency of the fistulae, indwelling catheters were placed into the openings created by the laser. For both horses, long-term follow-up did not reveal complications, and both owners were satisfied with results of the procedure. The authors recommend this procedure for horses that are unresponsive to medical treatment for chronic guttural pouch empyema.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Dexamethasone; Ear Diseases; Empyema; Endoscopy; Eustachian Tube; Female; Horse Diseases; Horses; Laser Therapy; Male; Penicillin G Procaine; Phenylbutazone; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination

Acanthamoeba was implicated as the causative agent of chronic meningitis in three apparently immunocompetent children. Diagnosis was established by cerebrospinal fluid wet mount examination and culture. Two children improved rapidly with combination oral therapy composed of trimethoprim-sulfamethoxazole, rifampin and ketoconazole.

Topics: Acanthamoeba; Administration, Oral; Amebiasis; Animals; Anti-Infective Agents; Antifungal Agents; Child; Child, Preschool; Chronic Disease; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Ketoconazole; Magnetic Resonance Imaging; Male; Meningitis; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

We report a 60-year-old immunocompetent patient with chronic biliary isosporiasis who failed to respond to orally administered cotrimoxazole prophylaxis and orally administered treatment with nitazoxanide, a 5-nitrothiazole benzamide compound. Severe malabsorption was regarded as responsible for the subtherapeutic levels of nitazoxanide in plasma and bile, resulting in treatment failure. Intravenously administered cotrimoxazole stopped the shedding of Isospora belli oocysts in bile within 5 days, excluding initially suspected resistance to cotrimoxazole. Patients with malabsorption and cholangitis due to Coccidia such as Isospora belli and Cryptosporidium spp. or due to protozoa that cause microsporidiasis seem to be predisposed to fail to respond to otherwise effective treatment.

Topics: Administration, Oral; Animals; Anti-Infective Agents; Antiprotozoal Agents; Bile; Chronic Disease; Humans; Immunocompetence; Injections, Intravenous; Isospora; Isosporiasis; Male; Middle Aged; Nitro Compounds; Thiazoles; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Comparatively few cases of mycetoma ("Madura foot") have been reported in Australia, and only one caused by Nocardia brasiliensis. We report two Aboriginal women from remote communities in central Australia who presented with longstanding mycetomas caused by this organism. Difficulties in diagnosis substantially delayed commencement of effective treatment, illustrating the need to consider this condition in chronic suppurative skin infection.

Topics: Adult; Anti-Bacterial Agents; Biopsy; Chronic Disease; Debridement; Female; Humans; Mycetoma; Native Hawaiian or Other Pacific Islander; Nocardia; Nocardia Infections; Northern Territory; Rural Health; Trimethoprim, Sulfamethoxazole Drug Combination

The involvement of the central nervous system in paracoccidioidomycosis is more frequent than previously thought. The first reference to the possibility that Paracoccidioides brasiliensis could affect the central nervous system was by Pereira & Jacobs in 1919. Since then, a great number of other studies has showed this form of clinical behavior and, in some of them, the frequency has ranged 27.27%. We report a clinical case of a 34-year-old white Brazilian woman admitted because of bacterial pneumonia. In the sixth day of admission, the patient developed cerebellar symptomatology with nausea, vomiting, dysmetria and gait disturbance. Central nervous system computer tomographic scanning disclosed a hypodense lesion in the right cerebellar hemisphere. The patient was submitted to surgery with total excision of the lesion. Histopathological examination confirmed the diagnosis of neuroparacoccidioidomycosis. Coadjuvant treatment with sulfamethoxazole-trimetoprim was introduced. The patient had a good outcome and was discharge 30 days after surgery.

Topics: Adult; Antifungal Agents; Brain Abscess; Chronic Disease; Female; Humans; Paracoccidioidomycosis; Trimethoprim, Sulfamethoxazole Drug Combination

An 86-year-old woman presented with a chronic granulomatous skin lesion on the dorsal aspect of her left hand. Histologic examination showed pseudoepitheliomatous hyperplasia and a dense dermal infiltrate largely composed of lymphocytes and histiocytes. Abscess formation and fibroblastic proliferation were also present. Use of Fite, Giemsa, and periodic acid-Schiff stains did not show specific organisms. The gram-negative bacillus Serratia marcescens was the only microorganism isolated from all cultures performed. Trimethoprim-sulfamethoxazole, 960 mg every 12 hours for 20 days (orally), was given and resulted in complete disappearance of the lesion and negative culture findings. Cutaneous infection by S marcescens may represent a distinctive entity, whose clinical and possible pathogenic features are presented here.

Topics: Aged; Aged, 80 and over; Biopsy; Chronic Disease; Female; Humans; Serratia Infections; Serratia marcescens; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a case of disseminated nocardiosis in a 53-year-old male allogeneic marrow recipient with chronic GVHD, 15 years post BMT. Six months prior to admission he was treated for recurrent chronic GVHD with corticosteroids with a good response. He deteriorated subsequently while still on steroids requiring admission for fever, anorexia, weight loss, productive cough and progressive dyspnoea. On admission he had multiple nodular lesions on chest roentgenogram and subsequently grew Nocardia farcinica in blood culture. N. farcinica is rare post BMT, has a high mortality, is resistant to various antibiotics and needs prolonged antimicrobial therapy. We report the successful management of our patient with single agent trimethoprim-sulphamethoxazole.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Bone Marrow Transplantation; Chronic Disease; Graft vs Host Disease; Humans; Male; Middle Aged; Nocardia; Nocardia Infections; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

The combination of trimethoprim (TMP) and sulphamethoxazole (SMX) is commonly used for the prevention of cerebral toxoplasmosis although there is no firm experimental basis to support this regimen. We used strain RH tachyzoites for challenge in the acute murine model of toxoplasmosis and found that TMP administered as a single agent, failed to eradicate toxoplasma even at the highest dose (70 mg/kg per day). SMX alone at 600 mg/kg per day, protected ten out of ten mice, although inoculation of brain from surviving animals to naive mice resulted in the development of an encephalitis. When combined, TMP (60 mg/kg per day) and SMX (300 mg/kg per day) protected ten out of ten mice and gave a 'cure' in four out of four mice. In the chronic cystogenic murine models, the combination TMP plus SMX administered from day 5 for 15 days or from day 28 for 288 days, gave protection and even apparent toxoplasmal eradication ('cure') at the highest dosing (60/300 mg/kg per day). However, microscopic severe encephalitis was found in mice classified as 'cured' after reinoculation. This result makes the interpretation of 'cure' very difficult. In conclusion TMP and SMX act synergistically, SMX being the more active arm of the combination. The combination was efficient in preventing the lethal development of chronic toxoplasma encephalitis, but did not guarantee complete recovery.

Topics: Animals; Chronic Disease; Disease Models, Animal; Drug Evaluation; Mice; Sulfamethoxazole; Toxoplasmosis, Animal; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder.. After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion.. Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Topics: Anti-Bacterial Agents; Chronic Disease; Cystoscopy; Electrocoagulation; Escherichia coli Infections; Female; Follow-Up Studies; Hematuria; Histiocytes; Humans; Malacoplakia; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

A rare case of pulmonary nocardiosis was presented in a nonimmunocompromised patient who had chronic airway obstruction and bronchiectasis without corticoid treatment. The microbial diagnosis was established after isolating Nocardia in bronchial aspirate and sputum samples. An in vitro study showed sensitivity only to imipenem, netilmicine, amikacin and ofloxacin. The evolution was chronic, with multiple clinical recurrences in spite of prolonged antibiotic treatment. Finally, the eradication of Nocardia was achieved with the combination of imipenem and amikacin.

Topics: Amikacin; Anti-Bacterial Agents; Bronchiectasis; Chronic Disease; Drug Therapy, Combination; Humans; Imipenem; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia asteroides; Nocardia Infections; Recurrence; Respiratory Tract Infections; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

We report three adult cases of very chronic, extensive infection of the lower limbs due to Mycobacterium marinum. The patients were from South Pacific islands and, clinically, the widespread warty plaques resembled chromomycosis. One was associated with severe lymphoedema. All three patients gave a history of at least 20 years duration. The patients were otherwise well and not immunologically compromised. In all cases, the organism was identified on tissue cultures and was not seen on histopathology. The mycobacteria were sensitive to most antibiotics tested in vitro. The patients were treated with a combination of rifampicin and cotrimoxazole with good results.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Chromoblastomycosis; Chronic Disease; Culture Techniques; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Leg Dermatoses; Lymphedema; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Pacific Islands; Rifampin; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To monitor trimethoprim and sulfamethoxazole plasma levels in patients with AIDS-associated Pneumocystis carinii pneumonia.. Trimethoprim-sulfamethoxazole steady-state plasma concentrations were measured by high-pressure liquid chromatography during 37 episodes of Pneumocystis carinii pneumonia in patients with AIDS. Initially, 15-23 mg/kg/day trimethoprim and 75-115 mg/kg/day sulfamethoxazole were given i.v. Assuming a therapeutic range for trimethoprim from 4 to 10 microg/ml, the doses were adjusted if trimethoprim levels were found to be outside this range.. Mean concentrations were 6.7+/-3.3 g/ml for trimethoprim and 187+/-56 microg/ml for sulfamethoxazole. A widespread inter-patient range was found and could be decreased after dose adjustment. Enzyme inducing co-medication did not influence plasma concentrations. In patients with coexisting chronic liver disease, significantly increased sulfamethoxazole plasma levels were observed. A correlation could be demonstrated between serum creatinine and trimethoprim plasma levels. Adverse reactions associated with co-trimoxazole occurred during 65% of treatment periods and increased with increasing trimethoprim-sulfamethoxazole levels, as well as increasing length of treatment. Therapy only had to be prematurely discontinued in one patient. Overall mortality was 2.7%. Monitoring of co-trimoxazole levels during the treatment of P. carinii pneumonia in AIDS may help in reducing the high variability of plasma-concentrations and in avoiding severe side-effects especially associated in patients with chronic liver disease or renal failure.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Chromatography, High Pressure Liquid; Chronic Disease; Drug Monitoring; Female; Humans; Kidney; Liver Diseases; Male; Middle Aged; Pneumonia, Pneumocystis; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of pulmonary Nocardia (N.) otitidiscaviarum infection in a 76-year-old man with chronic respiratory infection. The patient responded poorly to intravenous imipenem and oral minocycline, but later improved after treatment with trimethoprim-sulfamethoxazole. Pulmonary infection with N. otitidiscaviarum should be considered in the differential diagnosis of chronic respiratory infections. Further studies are needed to evaluate the correlation between species and drug susceptibility.

Topics: Aged; Agricultural Workers' Diseases; Bronchoalveolar Lavage Fluid; Chronic Disease; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Imipenem; Male; Microbial Sensitivity Tests; Minocycline; Nocardia; Nocardia Infections; Opportunistic Infections; Pneumonia, Bacterial; Species Specificity; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Animals; Anti-Bacterial Agents; Antidiarrheals; Child, Preschool; Chronic Disease; Diarrhea; Drug Therapy, Combination; Eucoccidiida; Humans; Infant; Intestinal Diseases, Parasitic; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Animals; Child; Chronic Disease; Coccidiosis; Diarrhea; Eucoccidiida; Feces; Humans; Peru; Trimethoprim, Sulfamethoxazole Drug Combination

One hundred and fifty-one children aged 2-6 years old suffering from chronic rhinitis were followed and treated for periods of 3-6 months. Seventy-five children were treated with antihistamines (AH) and 76 with antibiotics (AB). Significant statistic difference was found between pre-school children and school children. The differences were both with the nature of the symptoms, and reaction to treatment. While 49% of the school children recovered with AH treatment, only 14% of the pre-school children did. On the other hand, 58% of the pre-school children recovered with AB treatment while only 35% of the older children did. From our results it is clear that in many children bacterial infection is the cause for chronic rhinitis. In pre-school children it is the main cause, while in older children it is the cause in about a third of the cases. It is also important to remember that although allergy might be the basic reason for rhinitis, in certain age groups a secondary bacterial infection might interfere with the efficiency of antiallergic treatment.

Topics: Age Factors; Astemizole; Bacterial Infections; Carbolines; Child; Child, Preschool; Chronic Disease; Follow-Up Studies; Health Status; Histamine H1 Antagonists; Humans; Linear Models; Prognosis; Recurrence; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Suppuration; Trimethoprim, Sulfamethoxazole Drug Combination

A case of prolonged urinary tract infection caused by Mycobacterium fortuitum in a 56-year old female patient is reported. The infection, which was resistant to therapy with conventional antituberculous agents, responded well to a combination of trimethoprim, sulfamethoxazole and doxycycline.

Topics: Chronic Disease; Doxycycline; Drug Therapy, Combination; Female; Humans; Middle Aged; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We treated 15 men who had chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin with 400 mg. norfloxacin twice daily for 28 days. All pathogens were susceptible to norfloxacin and absent in prostatic fluid cultures obtained during therapy. One patient had negative post-therapy prostatic fluid cultures but was lost to followup at 1 month. Of the 14 patients followed for at least 6 months 9 (64%) were cured of the original infection, including 6 who have remained uninfected and have had negative prostatic secretion and urine cultures for at least 2 years (1), 1 year (2) or 6 months (3). In 3 patients urinary tract infections recurred with new pathogens at 6, 560 and 820 days after post-therapy negative prostatic fluid cultures. Bacterial prostatitis with the original pathogen recurred in 5 patients within 2 months of completing therapy. The bacteria remained susceptible to norfloxacin but could not be eradicated with 30 to 90 days of additional norfloxacin therapy. Cures were achieved in 9 of 12 patients with Escherichia coli, none of 2 with Pseudomonas prostatitis and 3 of 5 with prostatic calculi. No patient experienced significant adverse effects. The data suggest that norfloxacin is effective and safe for the treatment of refractory chronic bacterial prostatitis.

Topics: Carbenicillin; Chronic Disease; Escherichia coli Infections; Follow-Up Studies; Humans; Male; Middle Aged; Norfloxacin; Prostatitis; Pseudomonas Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Botryomycosis is a rare and chronic but readily treatable form of mycetoma. It is caused by a persistent bacterial infection and is distinguished by the formation of grains and multiple sinuses in the skin. The most usual cause is caused by Staphylococcus aureus. The authors' experience with four Transvaal cases is reported. In one case there was destruction of the skull and penetration of the cranial cavity by the botryomycotic process. Treatment with a range of common antistaphylococcal antibiotics led to astonishingly rapid recovery. Among the drugs used, cotrimoxazole was, perhaps, the most practical.

Topics: Adult; Africa; Aged; Chronic Disease; Humans; Male; Mycetoma; Scalp Dermatoses; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with chronic prostatitis have an increased number of white blood cells in expressed prostatic secretion. Two groups can be separated, one is characterized by uropathogenic bacteria in expressed prostatic secretion and recurrent urinary tract infections, chronic bacterial prostatitis. In this group an immune response to the bacteria has been demonstrated. Patients belonging to the other group, non-bacterial prostatitis, have similar symptoms. Many harbour Gram-positive bacteria in a high number, often Staphylococcus epidermidis in expressed prostatic secretion. This bacteria is usually not considered in prostatitis in spite of extreme high numbers. The etiology of non-bacterial inflammations is thus unknown. Forty-three per cent of the patients with chronic prostatitis had Gram-positive bacteria and 13% had Gram-negative in expressed prostatic secretion. Forty-four per cent of patients referred with symptoms of prostatitis did not have any aerobic bacteria at the prostatic level in sufficient number for the diagnosis bacterial prostatitis according to Meares and Stamey and form thus a third group. Antibiotic treatment of patients with non-bacterial prostatitis reduced symptoms but also changed the bacterial flora in urethral and prostatic secretion in such a way that uropathogens were found after treatment. In a group of patients an immunologic response to Staph. epidermidis was searched for by measuring complement components (C3c, C4c) as well as ceruloplasmin in serum and immunoglobulins (IgA, IgG) in seminal plasma. A specific ELISA method to estimate antibodies in serum against Staph. epidermidis was tested. No specific pattern separated patients from controls or patients with Gram-negative bacteria from patients with Gram-positive bacteria. Staphylococcus saprophyticus in cultures from men with prostatitis were more frequent in the third quarter of the year. The bacteria seemed to appear during or after antibiotic treatment but disappeared spontaneously during a follow-up period of six months. Treatment with the surfactant sodium pentosanpolysulphate, a heparinoid, given orally to patients with chronic prostatitis reduced concomitant pain in muscles and joints. The possibility of an altered host factor function in the polymorphonuclear leucocytes of patients with chronic non-bacterial prostatitis colonized with Staph. epidermidis was investigated. Chemotaxis, phagocytosis and intracellular killing were reduced in vitro and may to a part expla

Topics: Adult; Antibodies, Bacterial; Cefadroxil; Chronic Disease; Double-Blind Method; Enzyme-Linked Immunosorbent Assay; Humans; Male; Neutrophils; Pentosan Sulfuric Polyester; Prostatitis; Staphylococcal Infections; Staphylococcus epidermidis; Trimethoprim, Sulfamethoxazole Drug Combination

Staphylococcus saprophyticus was isolated in 17 percent (12 of 71 men) during one year, but with a peak in August and September to 21 percent in patients referred to the urology department with a suspicion of chronic bacterial prostatitis. Seven of the 12 men had S. saprophyticus in highest number at the prostatic level. Three of these were designated as chronic bacterial prostatitis. In this study the occurrence of S. saprophyticus appears to follow, and possibly depends on, previous antibiotic therapy. S. saprophyticus disappeared without treatment in all cases.

Topics: Adult; Cefadroxil; Chronic Disease; Humans; Incidence; Male; Prostatitis; Seasons; Staphylococcal Infections; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Chronic Disease; Drug Combinations; Female; Humans; Male; Osteomyelitis; Penicillinase; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Chronic bronchitis is characterized by chronic, productive cough present on most days for at least three months of the year. Differential diagnosis must exclude an endobronchial obstructive lesion, asthma, nocturnal aspiration, bronchiectasis, cystic fibrosis, and immotile cilia syndrome. The most characteristic finding in patients with chronic bronchitis is hypertrophy of the mucous glands and goblet cells.

Topics: Alcoholism; Amoxicillin; Ampicillin; Animals; Bronchitis; Bronchodilator Agents; Chronic Disease; Diagnosis, Differential; Dogs; Drug Combinations; Humans; Ipratropium; Klebsiella Infections; Metaproterenol; Respiratory Tract Infections; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A previously undescribed chronic diarrhea syndrome affected 122 residents of Brainerd, Minn, between December 1983 and July 1984. The illness lasted at least one year for 75% of case-patients and was characterized by acute onset, marked urgency, a lack of systemic symptoms, and a failure of response to antimicrobial agents. Clinical and laboratory data indicate that the diarrhea was caused by a secretory mechanism. Consumption of raw milk from a single dairy was associated with illness (odds ratio, 28.3; 95% confidence interval, 9.0 to 89.0). A median incubation period of 15 days was determined for seven case-patients. Possible secondary transmission was noted in one family. Extensive laboratory examination did not identify an etiologic agent. Outbreaks or sporadic cases of a similar illness have occurred in at least seven states; the outbreaks were less extensively investigated and findings were not published, but raw milk consumption was common in the affected persons. This illness appears to represent a previously unrecognized but important clinical entity and public health problem. The etiology and effective therapy for this illness must be determined by further studies of sporadic cases and outbreaks.

Topics: Aged; Animals; Cattle; Child, Preschool; Chronic Disease; Diarrhea; Disease Outbreaks; Double-Blind Method; Drug Combinations; Epidemiologic Methods; Fecal Incontinence; Feces; Female; Follow-Up Studies; Food Microbiology; Humans; Male; Milk; Minnesota; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child; Chronic Disease; Coccidiosis; Diarrhea; Drug Combinations; Female; Humans; Intestinal Diseases, Parasitic; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Plasma and prostatic fluid (PF) concentrations of co-trimoxazol (TMP/SMZ) were investigated on 16 patients with subacute or chronic prostatitis. Co-trimoxazol-forte was given perorally, 2X 1 tablet (2X 160 mg TMP/800 mg SMZ), daily. TMP-concentrations in PF were 3.3 micrograms/ml and 2.6 micrograms/ml three and six hours after peroral application (days two and three) respectively. Compared to the concentrations of TMP in plasma, there was an increase by the factor 2.0-3.7. The corresponding concentrations of SMZ in PF were 7.7 micrograms/ml and 10.4 micrograms/ml 3 and 6 hours after medication--i.e. 32% of the plasma concentrations.

Topics: Administration, Oral; Anti-Infective Agents, Urinary; Biological Availability; Chronic Disease; Drug Combinations; Humans; Kinetics; Male; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty men with cytologically confirmed chronic prostatitis were treated for 3 months by consecutive p.o. administration of doxycycline, sulfamethoxazole/trimethoprim, and cephalexin. The subjective symptoms, palpatory findings, secretory capacity of the accessory genital glands (values of acid phosphatase and fructose in the seminal plasma) were evaluated. The cytologic findings from the expressed prostatic fluid and semen analysis before and after the treatment were also studied. Approximately 60% of the patients were cured of the subjective symptoms. The palpatory findings disappeared in 50% of the cases. The cytologic findings became normal in 70% of the patients (inflammatory cells less than 25/HPF). The secretory function of the prostate and the seminal vesicles was improved in 50% and 25%, respectively, of the patients, and the quantitative and qualitative motility and viability of the spermatozoa after treatment were significantly enhanced.

Topics: Administration, Oral; Adult; Anti-Infective Agents, Urinary; Cephalexin; Chronic Disease; Doxycycline; Drug Combinations; Drug Therapy, Combination; Humans; Male; Prostatitis; Spermatozoa; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Chronic non-bacterial prostatitis is a difficult condition to diagnose accurately either by symptoms and signs or by investigations. Four groups of patients were assessed for the number of leucocytes and the presence of pathogens in expressed prostatic secretions before and after treatment with co-trimoxazole two tablets twice daily for three months. The pretreatment findings suggest that the upper limit of normal for the number of leucocytes in expressed prostatic secretions is about five per microscope field (X 40 magnification) and that for the cell count about 0.5 X 10(9)/l using the method described. Increased microscopical cell estimations and cell counts in the expressed prostatic secretions of patients with symptoms of prostatitis and those with recurrent non-specific urethritis seem to indicate the presence of prostatitis.

Topics: Adult; Bacteria; Cell Aggregation; Chronic Disease; Drug Combinations; Humans; Leukocyte Count; Leukocytes; Male; Middle Aged; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Review of the treatment of chronic non-bacterial prostatitis, defined by the presence of more than 500 leucocytes per mm3 in the expressed prostatic secretion (EPS), showed symptomatic response after 3 months of minocycline, trimethoprim, co-trimoxazole or diazepam. Reduction in the EPS cell count was most marked with minocycline, trimethoprim was less effective and poor results were obtained with co-trimoxazole and diazepam. In the absence of established treatment for chronic non-bacterial prostatitis it is suggested that antimicrobial therapy is worth consideration.

Topics: Adult; Anti-Infective Agents, Urinary; Chronic Disease; Diazepam; Drug Combinations; Humans; Leukocyte Count; Male; Minocycline; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Chronic Disease; Coccidiosis; Drug Combinations; Giardia; Humans; Intestinal Diseases, Parasitic; Isospora; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination