trimethoprim--sulfamethoxazole-drug-combination and Cicatrix

The role of antimicrobial prophylaxis for the prevention of recurrent urinary tract infections in children with vesicoureteral reflux that was identified following a urinary tract infection has been the source of considerable debate. Prior studies had failed to show a benefit in the prevention of recurrent infection. The National Institutes of Health funded the Randomized Intervention for Vesicoureteral Reflux (RIVUR) study to determine if there was a benefit to the use of prophylaxis. Results of the RIVUR study indicated that there was a 50% reduction in the risk of recurrent urinary tract infection in those children on the prophylaxis arm. Adverse events with the use of prophylaxis were noted to be few. Renal scarring was noted in only a small number of children at study entry and no reduction in scarring was noted between the placebo and the treated groups. The impact of the RIVUR study on the current evaluation and management of children with urinary tract infections and vesicoureteral reflux is detailed.

Topics: Anti-Bacterial Agents; Child, Preschool; Cicatrix; Humans; Infant; Kidney Diseases; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

We have described a case of rhinopharyngeal rhinoscleroma, and reviewed the clinical behavior and management of this disease. Selective long-standing antibiotic treatment was successful in halting the process. Treatment of the advanced cicatrix with carbon-dioxide laser vaporization yielded excellent results.

Topics: Adult; Betamethasone; Cicatrix; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Humans; Klebsiella pneumoniae; Laser Therapy; Male; Rhinoscleroma; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Child, Preschool; Cicatrix; Humans; Infant; Kidney; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

There has been intense discussion on the effectiveness of continuous antibiotic prophylaxis for children with vesicoureteral reflux, and randomized, controlled trials are still needed to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis. In this multicenter, open-label, randomized, controlled trial, we tested the effectiveness of antibiotic prophylaxis in preventing recurrence of pyelonephritis and avoiding new scars in a sample of children who were younger than 30 months and vesicoureteral reflux.. One hundred patients with vesicoureteral reflux (grade II, III, or IV) diagnosed with cystourethrography after a first episode of acute pyelonephritis were randomly assigned to receive antibiotic prophylaxis with sulfamethoxazole/trimethoprim or not for 2 years. The main outcome of the study was the recurrence of pyelonephritis during a follow-up period of 4 years. During follow-up, the patients were evaluated through repeated cystourethrographies, renal ultrasounds, and dimercaptosuccinic acid scans.. The baseline characteristics in the 2 study groups were similar. There were no differences in the risk for having at least 1 pyelonephritis episode between the intervention and control groups. At the end of follow-up, the presence of renal scars was the same in children with and without antibiotic prophylaxis.. Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and had vesicoureteral reflux grades II through IV.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Vesico-Ureteral Reflux

Co-trimoxazole has been reported as a common culprit drug for various cutaneous adverse drug reactions (CADRs). However, information on genotypic and phenotypic characteristics is still limited. We aimed to study clinical characteristics, genetic suitability, laboratory findings, and treatment outcomes in patients with co-trimoxazole-induced CADR and determine variables associated with severe cutaneous adverse reactions (SCARs).. The medical records of all patients diagnosed with co-trimoxazole-induced CADR during October 2015 and October 2021 were reviewed. Clinical characteristics and laboratory investigation with an emphasis on human leukocyte antigen (HLA) class I and HLA-DRB1 results linked to subtypes of cutaneous adverse reactions were evaluated.. Seventy-two patients diagnosed with co-trimoxazole-induced CADR were included in the study. Mean age at diagnosis was 38.0 ± 14.6 years old, and 72% were female. Subtypes of reactions included maculopapular eruption (MPE; 56.9%), drug reaction with eosinophilia and systemic symptoms (DRESS; 23.6%), Stevens-Johnson syndrome (SJS; 12.5%), fixed drug eruption (4.2%), and urticaria (2.8%). Characteristics that were significantly associated with SCARs included male gender (OR = 3.01, 95% CI: 1.04-8.75), HIV infection (OR = 3.48, 95% CI: 1.13-10.75), prophylactic use of co-trimoxazole (OR = 4.89, 95% CI: 1.54-15.57), and co-trimoxazole administration longer than 10 days (OR = 7.65, 95% CI: 2.57-22.78). HLA-B*38:02 was associated with co-trimoxazole-induced SJS, while HLA-A*11:01, HLA-B*13:01, and HLA-DRB1*12:01 were associated with co-trimoxazole-induced DRESS. HLA-B*52:01 was associated with co-trimoxazole-induced MPE.. Co-trimoxazole could induce various phenotypes of CADRs. Genotypic and phenotypic factors that may potentially predict co-trimoxazole-induced SCARs include male gender, HIV infection, prophylactic and prolonged drug use, as well as the presence of HLA-A*11:01, HLA-B*13:01, HLA-B*38:02, or HLA-DRB1*12:01 alleles.

Topics: Adult; Cicatrix; Female; HIV Infections; HLA-A Antigens; HLA-B Antigens; HLA-DRB1 Chains; Humans; Male; Middle Aged; Phenotype; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

The term bullous drug eruption connotes several heterogeneous diseases in which blisters occur as a complication of the administration of drugs. Blisters may occur in bullous erythema multiforme, fixed drug eruption, or severe dermatitis medicamentosa with blisters. The common denominator is thought to be a hypersensitivity reaction to a systemic medication. Nevertheless, little has been written about the blisters in these disorders, and neither common nor distinct pathogenic mechanisms have been proposed. We describe a patient who had a rapidly progressive bullous eruption that occurred within hours of receiving intravenous trimethoprim-sulfamethoxazole. Routine histologic study of lesional skin demonstrated subepidermal blisters. Transmission electron microscopy and immunomapping of various basement components revealed that the cleavage plane of the blister was well below the lamina densa. After healing of the blistering process, no scarring or milia formation was observed.

Topics: Basement Membrane; Blister; Cicatrix; Drug Eruptions; Drug Hypersensitivity; Epidermis; Female; Fluorescent Antibody Technique; Humans; Microscopy, Electron; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

The inability of antimicrobial agents to penetrate scarred renal tissue may explain some therapeutic failures. We examined the effect of scarring on antimicrobial therapy by using a unique animal model in which both kidneys were infected to the same degree but only one kidney was scarred. Scar formation could not explain the failure of ampicillin or nitrofurantoin to eradicate renal infection, but co-trimoxazole was less effective in the presence of tissue damage and scar formation than in their absence.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Bacteria; Cicatrix; Drug Combinations; Female; Kidney; Nitrofurantoin; Pyelonephritis; Rats; Rats, Inbred Strains; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination