trimethoprim--sulfamethoxazole-drug-combination and Emergencies

Topics: Acidosis; Aged; Anti-Infective Agents; Anuria; Arthritis, Rheumatoid; Coma; Emergencies; Humans; Hyperkalemia; Hypoglycemia; Kidney Failure, Chronic; Male; Myocardial Ischemia; Pneumocystis Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Age Factors; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Antineutrophil Cytoplasmic; Cyclophosphamide; Diagnosis, Differential; Drug Therapy, Combination; Emergencies; Glomerulonephritis; Granulomatosis with Polyangiitis; Hematuria; Humans; Immunosuppressive Agents; Male; Middle Aged; Plasmapheresis; Prednisone; Prognosis; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Carrier State; Child; Community-Acquired Infections; Drug Therapy, Combination; Emergencies; Family Health; Humans; Levofloxacin; Male; Methicillin-Resistant Staphylococcus aureus; Parents; Siblings; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

• To review a contemporary cohort of patients undergoing a transrectal ultrasound-guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits.. • The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed. • All patients received peri-procedural antibiotic prophylaxis with either ciprofloxacin or co-trimoxazole. • Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome. • Patient comorbidities and biopsy characteristics were reviewed for association with complications.. • Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. • Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. • Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. • All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. • No demographic or biopsy variables were particularly associated with development of a post-procedure complication.. • In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit. • No clinical or biopsy variables were directly associated with development of complications. • These data may be valuable when counselling patients before biopsy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Biopsy, Needle; Ciprofloxacin; Emergencies; Emergency Service, Hospital; Hematuria; Hospitalization; Humans; Ischemic Attack, Transient; Male; Middle Aged; Prostate; Prostatic Neoplasms; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional; Urinary Retention; Urinary Tract Infections

Topics: Anti-Infective Agents; Cephalosporins; Disease Progression; Emergencies; Exanthema; Humans; Male; Middle Aged; Penicillins; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis, Leukocytoclastic, Cutaneous

High rates of resistance to trimethoprim-sulfamethoxazole (TMP-SMX) among uropathogenic Escherichia coli are recognized, and concerns exist about emerging fluoroquinolone resistance.. Adults presenting to 11 US emergency departments with (1) flank pain and/or costovertebral tenderness, (2) temperature >38 degrees C, and (3) a presumptive diagnosis of pyelonephritis were enrolled; patients for whom 1 uropathogen grew on culture were analyzed. Epidemiologic and clinical data were collected at the time of care. The prevalence of E. coli in vitro antibiotic resistance and risk factors associated with TMP-SMX-resistant E. coli infection were determined.. Among 403 women with uncomplicated pyelonephritis caused by E. coli, the mean site rate of E. coli resistance to TMP-SMX was 24% (range, 13%-45%). Mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 1% and 3%, respectively. Only TMP-SMX exposure within 2 days before presentation and Hispanic ethnicity were associated with E. coli resistance to TMP-SMX (compared with resistance rates of approximately 20% among women lacking these risk factors); antibiotic exposure within 3-60 days before presentation, health care setting exposure within 30 days before presentation, history of urinary tract infections, and age >55 years were not associated with E. coli resistance to TMP-SMX. Among 207 patients with complicated pyelonephritis, mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 5% and 6%, respectively.. These results suggest that the prevalence of TMP-SMX-resistant infection among patients with uncomplicated pyelonephritis is > or =20% in many areas of the United States, and risk stratification cannot identify patients at low risk of infection. Rates of fluoroquinolone-resistant E. coli infection appear to be low among patients with uncomplicated pyelonephritis but higher among those with complicated infections. Fluoroquinolones should remain to be the preferred empirical treatment for women with uncomplicated pyelonephritis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergencies; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Levofloxacin; Middle Aged; Ofloxacin; Pyelonephritis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Anterior uveitis is a relatively rare adverse drug reaction when the prescription rate of sulfonamides is considered. Current medications should be included in the differential diagnosis of patients who present with uveitis, because discontinuation of the offending agent is mandatory to resolution of the problem. Lack of recognition and failure to discontinue the medication will increase the patient's risk of ocular injury.

Topics: Adult; Anti-Infective Agents, Urinary; Emergencies; Humans; Iritis; Male; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

Topics: Adult; Allopurinol; Burns; Critical Care; Drug Combinations; Emergencies; Female; Humans; Middle Aged; Phenylbutazone; Stevens-Johnson Syndrome; Sulfamethoxazole; Trauma Centers; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination