trimethoprim--sulfamethoxazole-drug-combination and Pneumonia--Pneumococcal

Each SAARC nation falls in the zone of high incidence of pneumococcal disease but there is a paucity of literature estimating the burden of pneumococcal disease in this region.. To identify the prevalent serotypes causing invasive pneumococcal disease in children of SAARC countries, to determine the coverage of these serotypes by the available vaccines, and to determine the antibiotic resistance pattern of Streptococcus pneumoniae.. We searched major electronic databases using a comprehensive search strategy, and additionally searched the bibliography of the included studies and retrieved articles till July 2014. Both community and hospital based observational studies which included children aged ≤12 years as/or part of the studied population in SAARC countries were included.. A total of 17 studies were included in the final analysis. The period of surveillance varied from 12-96 months (median, 24 months). The most common serotypes country-wise were as follows: serotype 1 in Nepal; serotype 14 in Bangladesh and India; serotype 19F in Sri Lanka and Pakistan. PCV-10 was found to be suitable for countries like India, Nepal, Bangladesh, and Sri Lanka, whereas PCV-13 may be more suitable for Pakistan. An increasing trend of non-susceptibility to antibiotics was noted for co-trimoxazole, erythromycin and chloramphenicol, whereas an increasing trend of susceptibility was noted for penicillin.. Due to paucity of recent data in majority of the SAARC countries, urgent large size prospective studies are needed to formulate recommendations for specific pneumococcal vaccine introduction and usage of antimicrobial agents in these regions.

Topics: Anti-Bacterial Agents; Asia, Western; Child; Child, Preschool; Chloramphenicol; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Pneumococcal Vaccines; Pneumonia, Pneumococcal; Serogroup; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination; Vaccines, Conjugate

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

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

Streptococcus pneumoniae is an important pathogen in many community-acquired respiratory infections in the United States and a leading cause of morbidity and mortality worldwide. Unfortunately, S. pneumoniae is becoming increasingly resistant to a variety of antibiotics. Results of recent surveillance studies in the United States show that the prevalence of penicillin-nonsusceptible S. pneumoniae ranges from 25% to >50%, and rates of macrolide resistance among pneumococci are reported to be as high as 31%. A high prevalence of resistance to other antimicrobial classes is found among penicillin-resistant strains. Newer quinolones (e.g., gatifloxacin, gemifloxacin, and moxifloxacin) that have better antipneumococcal activity in vitro are the most active agents and therefore are attractive options for treatment of adults with community-acquired respiratory infections. Efforts should be made to prevent pneumococcal infections in high-risk patients through vaccination.

Topics: 4-Quinolones; Anti-Bacterial Agents; Anti-Infective Agents; Drug Resistance; Drug Resistance, Multiple; Gene Frequency; Humans; Macrolides; Microbial Sensitivity Tests; Pneumococcal Vaccines; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is an important cause of morbidity and mortality in the United States. The provision of effective prophylaxis for pneumonia has become a major goal for both public health officials and individual physicians. Prophylaxis for community-acquired pneumonia is pathogen-specific and is directed toward the most common microorganisms that cause it. The 23-valent pneumococcal polysaccharide vaccine; the trivalent influenza vaccine; the Haemophilus b conjugate vaccine; and either trimethoprim-sulfamethoxazole, dapsone, or aerosolized pentamidine are recommended to prevent Streptococcus pneumoniae, influenza viruses, H. influenzae type b, and Pneumocystis carinii respectively. Except for the microorganisms listed above, the prevention of nosocomial pneumonia is not pathogen-specific. Rather, prevention of nosocomial pneumonia requires the use of infection control procedures, including patient and staff education; isolation of patients with highly contagious respiratory pathogens; vigorous hand washing; cleaning and sterilizaton of respiratory equipment; and use of sterile water in nebulizers and humidifiers. It also requires procedures to limit pooling and aspiration of secretions, such as positioning and rotation of the bed-bound patient; frequent suctioning of respiratory secretions using gloves and sterile suction catheters; and limiting enteral alimentation. Finally, selective decontamination of the digestive tract may be considered for intubated patients.

Topics: Anti-Bacterial Agents; Antifungal Agents; Bacterial Vaccines; Community-Acquired Infections; Cross Infection; Dapsone; Equipment Contamination; Haemophilus Vaccines; Hand Disinfection; Humans; Infection Control; Influenza Vaccines; Intubation, Intratracheal; Patient Education as Topic; Patient Isolation; Pentamidine; Personnel, Hospital; Pneumonia; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Pneumocystis; Pneumonia, Viral; Public Health; Sterilization; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control pneumococcal diseases. We investigated nasopharyngeal carriage of S. pneumoniae in Semarang, Indonesia.. A population-based survey was performed in Semarang, Indonesia. Nasopharyngeal swabs and questionnaires were taken from 496 healthy young (6-60 month-old) children and 45-70 year-old adults.. Forty-three percent of children aged 6-60 months and 11% of adults aged 45-75 years carried S. pneumoniae. Determinants of carriage were being a child (OR 7.7; 95% CI = 4.5-13.0), passive smoking (OR 2.1; 95% CI = 1.3-3.4), and contact with toddler(s) at home (OR 3.0; 95% CI = 1.9-4.7). The most frequent serotypes found were 6A/B and 15B/C. The current commercially available vaccines cover <50% serotypes found in children. Twenty-four percent of S. pneumoniae strains were penicillin non-susceptible, and 45% were resistant to cotrimoxazol.. The limited coverage of commercially available vaccines against the serotypes found in this population, and the high proportion of non-susceptibility to penicillin and cotrimoxazol suggest the need for region-specific information and strategies to control S. pneumoniae.

Topics: Adult; Anti-Infective Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Indonesia; Infant; Male; Middle Aged; Nasopharynx; Penicillins; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

A new chemotherapeutic drug oriprim was used for therapy of 36 patients with bronchopulmonary pathology. Its therapeutic efficacy was noted in 83.3% of the cases. In 6 patients oriprim therapy turned out to be ineffective as a result of early side-effects. The drug was effective in pneumococcal infection. In suspicion of anaerobic infection (B. fragilis, etc) oriprim was given in combination with metronidazole.

Topics: Administration, Oral; Bacterial Infections; Bronchitis; Clinical Trials as Topic; Drug Combinations; Enterobacteriaceae Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intramuscular; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in Africa. Antimicrobial resistance of S. pneumoniae to penicillin and other commonly used antibiotics has increased worldwide. However, prevalence data from the African region are sparse, especially with regard to adults.. In this study, adult patients presenting at an urban referral hospital in central Mozambique were screened for pneumococcal pneumonia during an 8-week period in 2010: Patients with a respiratory syndrome underwent chest radiography and a sputum sample was collected for pneumococcal culture and antimicrobial susceptibility testing. A urine sample was tested for the presence of pneumococcal antigen.177 patients with a respiratory syndrome were included. Overall, 41/177 (23%) patients fulfilled criteria for definite or probable pneumococcal pneumonia and in the group of patients with a positive chest x-ray this concerned 35/86 (41%) patients. 166 sputum cultures yielded 16 pneumococcal strains. One mg oxacillin disc testing identified potential penicillin resistance in 7/16 (44%) strains. Penicillin minimal inhibitory concentrations (MICs) were measured for 15 of these strains and ranged from <0.016-0.75 mg/L. No MICs >2 mg/L were found, but 3/15 (20%) pneumococcal strains had MICs >0.5 mg/L. All pneumococci were sensitive to erythromycin as measured by disc diffusion testing, whereas 44% was resistant to trimethoprim-sulfametoxazole.. The proportion of pneumonia cases attributable to pneumococcus appeared to be high. Whilst none of the S. pneumoniae strains tested were penicillin resistant, standard penicillin dosing for pneumonia may be insufficient given the observed range of pneumococcal penicillin MICs.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cross-Sectional Studies; Drug Resistance, Bacterial; Erythromycin; Female; Hospitals, Urban; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mozambique; Oxacillin; Penicillins; Pneumonia, Pneumococcal; Prospective Studies; Sputum; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 76-year-old man was admitted to our hospital because of severe anemia. Routine screening revealed a sigmoid adenocarcinoma, and he underwent sigmoidectomy. Post-operatively, he developed rapidly progressive glomerulonephritis. He was positive for myeloperoxidase anti-neutrophil cytoplasmic antibody. A renal biopsy revealed idiopathic crescentic glomerulonephritis of the pauci-immune type. He was treated with methylprednisolone semi-pulse therapy with clinical improvement. After the steroid pulse therapy, he was given oral prednisolone, 40 mg per day, and oral trimethoprim (TMP), 160 mg, and sulfamethoxazole (SMX), 800 mg twice weekly for chemoprophylaxis against pneumocystis pneumonia. One month after the initiation of TMP/SMX, he developed hyperkalemia and hyponatremia. His transtubular K gradient was low, and urinary potassium excretion was decreased. On the other hand, plasma renin activity and plasma aldosterone concentrations were within normal limits. These results suggested that TMP acted similarly to a potassium-sparing diuretic amiloride and reduced renal potassium excretion. Administration of calcium polystyrene sulfonate resulted in correction of the hyperkalemia without discontinuation of TMP/SMX. We emphasize that patients with impaired renal function are at the significant risk of developing trimethoprim-induced hyperkalemia even with chemoprophylaxis.

Topics: Adenocarcinoma; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibiotic Prophylaxis; Glomerulonephritis; Humans; Hyperkalemia; Immunocompromised Host; Male; Pneumonia, Pneumococcal; Postoperative Complications; Sigmoid Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination

The association between trimethoprim-sulfamethoxazole use and resistance among the major respiratory tract pathogens was investigated by comparing regional consumption of the drug to regional resistance in the following year in 21 central hospital districts in Finland. A total of 23,530 Streptococcus pneumoniae isolates, 28,320 Haemophilus influenzae isolates, and 14,138 Moraxella catarrhalis isolates were tested for trimethoprim-sulfamethoxazole susceptibility during the study period (1998-2004). Among the S. pneumoniae isolates, a statistically significant connection was found between regional consumption and resistance. No statistically significant connection was found between regional trimethoprim-sulfamethoxazole use and resistance among H. influenzae and M. catarrhalis isolates. According to our results, it seems that only in pneumococci can the development of trimethoprim-sulfamethoxazole resistance be influenced by restricting its use. However, trimethoprim-sulfamethoxazole remains an important antimicrobial agent because of its reasonable price. Hence, resistance to trimethoprim-sulfamethoxazole among these pathogens needs continuous monitoring.

Topics: Drug Resistance, Bacterial; Finland; Haemophilus Infections; Haemophilus influenzae; Humans; Moraxella catarrhalis; Moraxellaceae Infections; Pneumonia, Pneumococcal; Respiratory Tract Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to assess the factors implicated in an increased or decreased risk of pneumonia, with particular attention to the response to highly active antiretroviral therapy (HAART) and the effect of the polysaccharide 23-valent pneumococcal vaccination in 300 human immunodeficiency virus (HIV)-infected adults followed-up for a median of 35.6 months. Pneumococcal pneumonia occurred in 12 patients and all bacterial pneumonia (pneumonia caused by Streptococcus pneumoniae or other bacteria, as well as those with negative cultures but presumably bacterial in origin) in 40 patients. In the univariate analysis, immunodepressed patients (defined as those with less than 200 CD4+ T cell/microl), those without immunological response to HAART (defined as an increase of 25% of CD4+ T lymphocyte count), patients with previous admissions to hospital and those with cotrimoxazole or Mycobacterium avium intracellulare prophylaxis showed a higher incidence of both pneumococcal and all bacterial pneumonia. Multivariate analysis demonstrated that the presence of pneumococcal pneumonia was associated with a CD4+ lymphocyte count at the time of HIV diagnosis <200 cells/microl. The multivariate model that was more valid for prediction of all bacterial pneumonia included a CD4+ T cell count <200 cells/microl and absence of immunological response to HAART. Only in patients with a baseline CD4+ T cell count lower than 200/microl and immunological response to HAART, a near significant lower incidence of all bacterial pneumonia was observed after vaccination. Thus, these results do not support an important additional protective effect of 23-valent pneumococcal vaccine in HIV-patients with immunological response to HAART.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; HIV Infections; Humans; Immunity; Incidence; Male; Mycobacterium avium-intracellulare Infection; Pneumococcal Vaccines; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Humans; Penicillin Resistance; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

An imported case of pneumonia caused by penicillin-resistant Streptococcus pneumoniae occurred in a tourist, shortly after arriving in Barbados. The isolate was of serogroup 6 and exhibited intermediate resistance to penicillin. This was the first isolation of penicillin-resistant S. pneumoniae in Barbados.

Topics: Aged; Anti-Bacterial Agents; Barbados; Canada; Humans; Male; Penicillin Resistance; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The pneumococcus is a frequent cause of pneumonia and other serious infections among young children in developing countries. Defining the pattern of pneumococcal infection in these countries is important so that, with the advent of pneumococcal conjugate vaccines, rational vaccination policies can be developed.. Children younger than 5 years of age who attended clinics in a rural area of The Gambia, West Africa, were screened by assistants during a 2-year period. Children with predefined features suggestive of a diagnosis of pneumonia, meningitis or septicemia were referred to the Medical Research Council Field Station at Basse for investigation.. Of 2898 children investigated 103 cases of invasive pneumococcal disease (70 definite and 33 probable) were identified, suggesting that the incidence of this infection in the study community is at least 554/100,000/year in children younger than 1 year of age and 240/100,000/year in those younger than 5 years, rates many times higher than those found in industrialized societies. The mean age of presentation was 15 months; more boys than girls were affected. Cases of pneumonia were encountered 8 times more frequently than those of meningitis. Antibiotic resistance was rarely found and cases of pneumonia, but not meningitis, responded well to treatment. Case-fatality rates in children with pneumonia and meningitis were 1 and 55%, respectively. The most prevalent pneumococcal serotypes were types 6, 14, 19, 1 and 5.. About 60% of invasive pneumococcal infection in children in this community could potentially be prevented by a nine-valent pneumococcal conjugate vaccine (types 1, 4, 5, 6B, 9, 14, 18, 19F and 23) given at the ages of 2, 3 and 4 months.

Topics: Anti-Bacterial Agents; Bacteremia; Child, Preschool; Chloramphenicol; Female; Gambia; Humans; Incidence; Infant; Infant, Newborn; Male; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Pneumonia, Pneumococcal; Prevalence; Rural Population; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination

Strains of Streptococcus pneumoniae resistant to penicillin have not previously been reported in The Netherlands. Now we have to report the isolation in November 1988 of a multiresistant pneumococcus (minimal inhibitory concentration 2 mg/l) from sputum of a three-year-old child from Poland. We advise isolating patients from abroad (Spain, Poland) in hospital and checking their bacteriological status to prevent introduction of penicillin resistant pneumococci into the Dutch population.

Topics: Child, Preschool; Drug Resistance, Microbial; Female; Humans; Microbial Sensitivity Tests; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child, Preschool; Clindamycin; Drug Combinations; Erythromycin; Humans; Infant; Male; Meningitis, Pneumococcal; Middle Aged; Penicillin G; Penicillin Resistance; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination