trimethoprim--sulfamethoxazole-drug-combination and Leukocytosis

After appendectomy for perforated appendicitis children have traditionally been managed with intravenous broad-spectrum antibiotics for 5 to 10 days and then until fever and leukocytosis have resolved. We prospectively evaluated a protocol of hospital discharge on oral antibiotics when oral intake is tolerated-regardless of fever or leukocytosis-in a consecutive series of 80 children between one and 15 years of age who underwent appendectomy (38 open and 42 laparoscopic) for perforated appendicitis. At discharge subjects began a 7-day course of oral trimethoprim/sulfamethoxazole and metronidazole. Patients were discharged between 2 and 18 days postoperatively (mean 5.3 days). Sixty-six were discharged on oral antibiotics, and 28 of these had persistent fever or leukocytosis. Two patients (2.5%) developed postoperative intra-abdominal abscesses while inpatients. Wound infections developed in seven patients (8.8%) four of whom were on intravenous antibiotics. Among the 66 children who were discharged on oral antibiotics without having had an inpatient infectious complication there were three wound infections (4.4%). None of these patients had a fever or leukocytosis at discharge. We conclude that after appendectomy for perforated appendicitis children may be safely discharged home on oral antibiotics when enteral intake is tolerated regardless of fever or leukocytosis.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Anti-Infective Agents; Appendectomy; Appendicitis; Child; Child, Preschool; Decision Trees; Drug Administration Schedule; Drug Therapy, Combination; Enteral Nutrition; Female; Fever; Humans; Infant; Intestinal Perforation; Leukocytosis; Male; Metronidazole; Patient Discharge; Prospective Studies; Rupture, Spontaneous; Surgical Wound Infection; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Chryseobacterium arthrosphaerae is a gram-negative bacteria, known for its intrinsic multidrug resistance, which can lead to treatment difficulties.. A 56-year-old male had an indwelling external ventricular drainage catheter for 6 months and had been frequently treated with antibiotics for nosocomial infections. He showed cerebrospinal fluid pleocytosis and an abrupt fever during hospitalization.. He was diagnosed as a ventriculitis caused by Chryseobacterium arthrosphaerae (C arthrosphaerae).. Initially, we used ciprofloxacin as the backbone in combination with minocycline (and rifampin). However, fever and pleocytosis persisted, and improvement was slow. We then switched the minocycline and rifampin regiment to trimethoprim/sulfamethoxazole. Following this switch of antibiotics, the patient's pleocytosis rapidly improved, allowing the replacement of his external ventricular drainage catheters. C arthrospharae was no longer growing in cerebrospinal fluid and he was recovered from ventriculitis.. The patient remains alive without any incidence of C arthrosphaerae recurrence.. We propose trimethoprim/sulfamethoxazole alone or in combination with ciprofloxacin to be good candidates for the treatment of ventriculitis by C arthrosphaerae.

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Cerebral Ventriculitis; Chryseobacterium; Drainage; Drug Therapy, Combination; Humans; Leukocytosis; Male; Middle Aged; Minocycline; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is being increasingly recognized after solid organ transplantation but has not been reported after orthotopic heart transplantation. We present the case of a 51-year-old farmer who underwent orthotopic heart transplantation and was readmitted after 3 months in a severely immunosuppressed state with significant nonspecific complaints. He posed a diagnostic and management dilemma to all disciplines, but finally turned out to be harboring Brucella infection. He responded well to medical management and was discharged in a stable clinical status. Although rare, brucellosis should be included in the investigative workup for nonspecific symptoms after cardiac transplantation.

Topics: Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; C-Reactive Protein; Cattle; Dairy Products; Delayed Diagnosis; Doxycycline; Drug Therapy, Combination; Heart Transplantation; Humans; Immunocompromised Host; Immunoglobulin M; Immunosuppressive Agents; Leukocytosis; Male; Middle Aged; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 57 year old male with Whipple's disease. The patient was asymptomatic and an unexplained peripheral leucocytosis was found in a routine examination. It persisted as the only abnormality for one year and then he developed articular symptoms, diarrhoea and weight loss. The diagnosis was confirmed by duodenal biopsy five years later. The leucocyte count ranged between 14,000 and 22,000 leuc/mm3. Response to cotrimoxazole was favourable with disappearance of all signs and symptoms, including leucocytosis. In the last endoscopic control, eight years after initial manifestations, an intramucosal gastric adenocarcinoma was diagnosed.

Topics: Adenocarcinoma; Anti-Infective Agents; Biopsy; Duodenum; Follow-Up Studies; Gastrectomy; Humans; Leukocytosis; Male; Middle Aged; Stomach; Stomach Neoplasms; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

A patient is described who developed fever, chills and leucocytosis on two occasions following the administration of cotrimoxazole. This rare reaction simulating sepsis in patients treated with cotrimoxazole is of clinical importance.

Topics: Diagnosis, Differential; Drug Combinations; Female; Fever; Humans; Leukocytosis; Middle Aged; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination