trimethoprim--sulfamethoxazole-drug-combination and Pneumonia

Burkholderia cepacia complex consists of highly antibiotic resistant gram negative bacilli that are plant symbionts and also potential agents of human infection.  This bacterial family's claim to fame in clinical medicine is as the scourge of cystic fibrosis patients, in whom it is a notorious respiratory pathogen.  Outside of cystic fibrosis, it rarely comes to mind as an etiology of community acquired pneumonia with or without lung cavitation in immunocompetent hosts.  We describe a case of an otherwise healthy, community-dwelling man who presented with subacute cavitary lung disease, the causative organism of which turned out to be Burkholderia cepacia complex.  Our report is accompanied by a review of the literature, which identified an additional eleven cases in the same category.  We analyze all of the available cases for the emergence of any identifiable patterns or peculiarities.

Topics: Adolescent; Adult; Aftercare; Aged; Anti-Bacterial Agents; Bronchoalveolar Lavage; Burkholderia cepacia complex; Burkholderia Infections; Community-Acquired Infections; Diagnosis, Differential; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Immunocompetence; Male; Middle Aged; Onions; Plant Diseases; Pneumonia; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We reviewed medical records of all patients (n = 4) who underwent facial composite tissue allotransplantation (FCTA) at our center between April 2009 and May 2011; data were censored in June 2012. We searched for FCTA publications and reviewed them for infectious complications and prophylaxis strategies. Three patients received full and one partial FCTA at our institution. Two recipients were cytomegalovirus (CMV) Donor (D)+/Recipient (R)- and two CMV D+/R+. Perioperative prophylaxis included vancomycin, cefazolin and micafungin and was adjusted based on peritransplant cultures. Additional prophylaxis included trimethoprim-sulfamethoxazole and valganciclovir. Two recipients developed surgical site infection and two developed pneumonia early after transplantation. Both CMV D+/R- recipients developed CMV disease after discontinuation of prophylaxis, recovered with valganciclovir treatment and did not experience subsequent rejection. Other posttransplant infections included bacterial parotitis, polymicrobial bacteremia, invasive dermatophyte infection and Clostridium difficile-associated diarrhea. Nine publications described infectious complications in another 9 FCTA recipients. Early posttransplant infections were similar to those observed in our cohort and included pulmonary, surgical-site and catheter-associated infections. CMV was the most frequently described opportunist. In conclusion, infections following FCTA were related to anatomical, technical and donor/recipient factors. CMV disease occurred in D+/R- recipients after prophylaxis, but was not associated with rejection.

Topics: Adult; Anti-Infective Agents; Catheter-Related Infections; Cytomegalovirus; Cytomegalovirus Infections; Face; Female; Graft Rejection; Graft Survival; Humans; Male; Middle Aged; Pneumonia; Postoperative Complications; Prognosis; Surgical Wound Infection; Tissue Transplantation; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Empyema necessitatis is a rare complication of empyema in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall. Most cases of empyema necessitatis are related to Mycobacterium tuberculosis and, less commonly, to Actinomyces spp. and Streptococcus spp. Staphylococcus aureus has rarely been reported as the causative agent of empyema necessitatis, with the majority of S. aureus isolates being methicillin sensitive. Only two cases of empyema necessitatis due to methicillin-resistant S. aureus (MRSA) have been reported in the medical literature. We report the case of a 59-year-old Caucasian male who presented to our institution with complaints of pain in and swelling of his left upper chest of 2-months duration. A computed tomography scan of the chest showed an 8.1- by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle. A wedge resection of the left upper lung lobe revealed lung tissue with an organized pneumonia-like pattern associated with marked acute pleuritis. Blood and urine cultures and cultures of the left chest soft tissue mass grew MRSA. The patient was successfully treated with vancomycin followed by a 10-day outpatient course of ciprofloxacin and trimethoprim-sulfamethoxazole. This case represents an extremely rare manifestation of an increasingly dangerous bacterial pathogen.

Topics: Anti-Bacterial Agents; Blood; Ciprofloxacin; Empyema; Humans; Lung; Male; Methicillin Resistance; Middle Aged; Pneumonia; Radiography, Thoracic; Staphylococcal Infections; Staphylococcus aureus; Thorax; Trimethoprim, Sulfamethoxazole Drug Combination; Urine; Vancomycin; White People

Acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality in children under five years of age in developing countries. When hospitalisation is required, the usual practice includes administering parenteral antibiotics if a bacterial infection is suspected. This has disadvantages as it causes pain and discomfort to the children, which may lead to treatment refusal or reduced compliance. It is also associated with needle-related complications. In some settings this equipment is in short supply or unavailable necessitating transfer of the child, which increases risks and healthcare costs.. To determine the equivalence in effectiveness and safety of oral antibiotic compared to parenteral antibiotic therapies in the treatment of severe pneumonia in children between three months and five years of age.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005); MEDLINE (January 1966 to July 2005); EMBASE (January 1990 to July 2005) and LILACS (February 2005).. The review included published or unpublished randomised controlled trials (RCTs) and quasi-RCTs comparing any oral antibiotic therapy with any parenteral antibiotic therapy for the treatment of severe pneumonia in children from three months to five years of age.. The search yielded more than 1300 titles. Only three studies met all criteria for eligibility. One of the identified trials is yet to publish its results. We did not perform a meta-analysis because of clinical heterogeneity of therapies compared in the included trials.. Campbell 1988 compared oral co-trimoxazole versus intramuscular procaine penicillin followed by oral ampicillin in 134 children. At the seventh day of follow up, treatment failure occurred in 6/66 (9.1%) in the oral co-trimoxazole group and 7/68 (10.2%) in the combined-treatment group. The risk difference was -0.01% (95% confidence interval (CI) -0.11 to 0.09). The APPIS Group 2004 evaluated 1702 patients comparing oral amoxicillin versus intravenous penicillin for two days followed by oral amoxicillin. After 48 hours, treatment failure occurred in 161/845 (19%) in the amoxicillin group and 167/857 (19%) in the parenteral penicillin group. The risk difference was -0.4% (95% CI -4.2 to 3.3). The authors reported similar recovery in both groups at 5 and 14 days.. Oral therapy appears to be an effective and safe alternative to parenteral antibiotics in hospitalised children with severe pneumonia who do not have any serious signs or symptoms.

Topics: Administration, Oral; Ampicillin; Anti-Bacterial Agents; Child, Preschool; Humans; Infant; Injections, Intramuscular; Penicillin G Procaine; Pneumonia; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

Drug reactions in patients with HIV infection, e.g. fever or rash, are a frequently occurring clinical problem. These side effects particularly are observed with sulfonamides; however, many other drugs have also shown to induce allergic reactions when given to patients with HIV infection. The production of hydroxylamines has been put forward as one of the explanations for these high incidence of reactions on drugs. Since sulfonamides are the first choice of therapy for the treatment and prophylaxis of Pneumocystis carinii pneumonia, several strategies have been developed to circumvent drug reactions. In general rechallenge or desensitization are recommended in literature. This article discusses the results and risks of rechallenge and desensitization with sulfonamides or other drugs, as mentioned in the literature. Furthermore preliminary results of rechallenge with a sulfonamide, which is not metabolized into hydroxylamines, are presented. From the data in the literature it is concluded that desensitization should be preferred to rechallenge.

Topics: Anti-Infective Agents; Desensitization, Immunologic; Drug Hypersensitivity; Female; HIV Infections; Humans; Hydroxylamines; Male; Pneumonia; Sulfanilamides; Sulfonamides; 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

Topics: Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Ganciclovir; Humans; Immunocompromised Host; Mycoses; Pneumonia; Pneumonia, Pneumocystis; Pneumonia, Viral; Trimethoprim, Sulfamethoxazole Drug Combination

As the case presented here illustrates, nocardiosis, like other infections in which cell-mediated immunity plays a large defensive role, can relapse after apparent cure and occasionally at times remote from the original infection. Although relapse in patients with transplants has been cited as a reason for continued prophylaxis, only a few of these cases are adequately documented. This case supports the advice of those authors who give suppressive antibiotic therapy for the duration of immunosuppression in transplant recipients recovering from infections due to Nocardia sp. Alternatively, many transplant centers are routinely using TMP/SMX chemoprophylaxis in all solid organ transplantations to prevent opportunistic infections with Pneumocystis and Listeria sp. Primary prophylaxis has also been associated with a decreased incidence of nocardial infections.

Topics: Adult; Biopsy; Brain Abscess; Female; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Pneumonia; Recurrence; Time Factors; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A large number and variety of organisms can infect the lungs of persons with AIDS. An abnormal chest X-ray associated with pulmonary symptoms should trigger a vigorous search for an infectious agent. In many cases, if the patient is ambulatory, the workup can proceed on an outpatient basis. Pneumocystis carinii pneumonia is the most common infection and also one of the most readily treatable illnesses that these patients encounter. A careful and considered diagnostic approach is necessary to conserve the time and resources of both patients and healthcare providers.

Topics: Acquired Immunodeficiency Syndrome; Ambulatory Care; Cytomegalovirus Infections; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Opportunistic Infections; Pentamidine; Pneumonia; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

This article provides the pulmonary specialist with a summary description of these commonly used antimicrobial agents, including mode of action, antimicrobial spectrum, pharmacology, toxicity, indications for use, and recommended dosages.

Topics: Aminoglycosides; Anti-Bacterial Agents; Cystic Fibrosis; Drug Combinations; Drug Resistance, Microbial; Humans; Pentamidine; Pneumonia; Polymyxins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Pneumonia is the leading cause of mortality in under-five children and most of these deaths occur in South-East Asia and Africa. Fast breathing pneumonia if not treated can progress to lower chest indrawing pneumonia. Treatment recommendation by the World Health Organization (WHO) for fast-breathing pneumonia includes oral amoxicillin and cotrimoxazole (as an alternative). Due to limited access to health care facilities and skilled health care workers, many children are unable to receive antibiotics. Algorithm-based community case management of pneumonia through trained community health workers has resulted in a decline in morbidity and mortality in low- and middle-income countries (LMIC).. It was a cluster-randomized, unblinded, community-based trial conducted in the Matiari district of Sindh province, Pakistan. Lady Health Workers (LHWs) were trained in assessing, classifying, and managing fast-breathing pneumonia cases (Respiratory rate of >50 breaths/min) at home with oral amoxicillin for three days and with co-trimoxazole for five days in the intervention and control arms respectively. Children with fast-breathing pneumonia were screened by LHWs and were validated by the study by Community Health Workers (CHWs) within 48 hours. They were followed by the LHWs on days 2, 4, and 14 in intervention and on days 2, 6, and 14 in the control arm. Primary treatment failure was assessed on day 4 in intervention and day 6 in the control arm. A severe pneumonia trial was registered with ClinicalTrials.gov, number NCT01192789.. From February 2008 to March 2010, a total of 5876 children were enrolled by Lady Health Workers as fast breathing pneumonia. On validation visits of the CHWs, 728 (12%) children were excluded. A total of 4984 children were analysed as per protocol: 2480 in intervention and 2504 in control. There were 72 (2.9%) primary treatment failures in the intervention arm as compared to 102 (4%) in the control arm with a risk difference of -0.94 (-2.84%, 0.96%). Secondary treatment failures were almost equal in both arms (4 vs 7 cases). No deaths or serious adverse events were recorded.. This study shows that amoxicillin can be as effective as cotrimoxazole to treat fast-breathing pneumonia cases at the domiciliary level.. NCT01192789.

Topics: Amoxicillin; Anti-Bacterial Agents; Case Management; Child; Humans; Infant; Pakistan; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

No randomised controlled trial (RCT) has examined the efficacy of cotrimoxazole (CTX) prophylaxis in HIV-exposed uninfected (HEU) infants during the breastfeeding period, in this new era of effective prevention of mother-to-child transmission (PMTCT) prophylaxis. The efficacy of CTX prophylaxis has presently been demonstrated only in HIV-infected children. The absence of proven benefits in HEU breastfed infants associated with infectious diseases justifies an RCT as proposed. Herewith lies the rationale for conducting the proposed study.. A partially blinded RCT is proposed to evaluate the efficacy of CTX prophylaxis administered from 6 weeks of age to HEU infants receiving a PMTCT regimen. A non-inferiority design will be used, randomising 1298 infants to receive CTX or not to receive CTX. Participants will be reviewed at the following time points: 6 weeks (enrolment and randomisation), 10 weeks, 14 weeks, 4 months and monthly thereafter until 12 months of age. They will be evaluated for anthropometric growth, interval illness, CTX adherence, signs and symptoms of study drug toxicity, concomitant medication use, breastfeeding status and HIV infection status. The study will compare the incidence of grade 3 and grade 4 common childhood illnesses (focusing on pneumonia and diarrhoea) and all-cause mortality until 12 months of age. In a subset of participants, we will compare grade 3 and grade 4 haemoglobin and alanine aminotransferase results as well as investigate gut integrity.. The study has ethical approval from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BFC212/13).. PACTR201311000621110 and DOH-27-0614-4728; Pre-results.

Topics: Anti-Bacterial Agents; Anti-HIV Agents; Breast Feeding; Cause of Death; Diarrhea; Female; Growth Disorders; HIV; HIV Infections; Humans; Incidence; Infant; Infant Health; Infant Mortality; Infectious Disease Transmission, Vertical; Male; Morbidity; Mothers; Pneumonia; Pregnancy; Pregnancy Complications, Infectious; Research Design; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is a leading global cause of morbidity and mortality in children younger than 5 years. In Pakistan, the proportion of deaths due to pneumonia is higher in rural areas than it is in urban areas, with a substantial proportion of individuals dying at home because referral for care is problematic in such areas. We aimed to establish whether community case identification and management of severe pneumonia by oral antibiotics delivered through community health workers has the potential to reduce the number of infants dying at home.. We did a cluster-randomised controlled trial in Matiari district of rural Sindh, Pakistan. Public-sector lady health workers (LHWs) undertook community case management of WHO-defined severe pneumonia. The children in intervention clusters with suspected pneumonia were screened by LHWs and those diagnosed with severe pneumonia were prescribed oral amoxicillin syrup (90 mg/kg per day in two doses) for 5 days at home. Children in control clusters were given one dose of oral co-trimoxazole and were referred to their nearest health facility for admission and intravenous antibiotics, as per government policy. In both groups, follow-up visits at home were done at days 2, 3, 6, and 14 by LHW. The primary outcome was treatment failure by day 6 after enrolment. We matched and randomly allocated 18 clusters (union councils, the smallest administrative unit of the district) to either intervention and control using a computer-generated randomisation scheme. Analyses were done per-protocol. This trial is registered with ClinicalTrials.gov, number NCT01192789.. 2341 children in intervention clusters and 2069 children in control clusters participated in the study, enrolled between Feb 13, 2008, and March 15, 2010. We recorded 187 (8%) treatment failures by day 6 in the intervention group and 273 (13%) in the control group. After adjusting for clustering, the risk difference for treatment failure was -5·2% (95% CI -13·7% to 3·3%). We recorded three deaths, two by day 6 and one between days 7 and 14. We recorded no serious adverse events.. Public sector LHWs in Pakistan were able to satisfactorily diagnose and treat severe pneumonia at home in rural Pakistan. This strategy might effectively reach children with pneumonia in settings where referral is difficult, and it could be a key component of community detection and management strategies for childhood pneumonia.. US Agency for International Development through grants to John Snow Incorporation and Boston University, USA.

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Case Management; Child, Preschool; Community Health Workers; Humans; Infant; Pakistan; Pneumonia; Rural Health Services; Trimethoprim, Sulfamethoxazole Drug Combination

First dose oral co-trimoxazole and referral are recommended for WHO-defined severe pneumonia. Difficulties with referral compliance are reported in many low-resource settings, resulting in low access to appropriate treatment. The objective in this study was to assess whether community case management by lady health workers (LHWs) with oral amoxicillin in children with severe pneumonia was equivalent to current standard of care.. In Haripur district, Pakistan, 28 clusters were randomly assigned with stratification in a 1:1 ratio to intervention and control clusters by use of a computer-generated randomisation sequence. Children were included in the study if they were aged 2-59 months with WHO-defined severe pneumonia and living in the study area. In the intervention clusters, community-based LHWs provided mothers with oral amoxicillin (80-90 mg/kg per day or 375 mg twice a day for infants aged 2-11 months and 625 mg twice a day for those aged 12-59 months) with specific guidance on its use. In control clusters, LHWs gave the first dose of oral co-trimoxazole (age 2-11 months, sulfamethoxazole 200 mg plus trimethoprim 40 mg; age 12 months to 5 years, sulfamethoxazole 300 mg plus trimethoprim 60 mg) and referred the children to a health facility for standard of care. Participants, carers, and assessors were not masked to treatment assignment. The primary outcome was treatment failure by day 6. Analysis was per protocol with adjustment for clustering within groups by use of generalised estimating equations. This study is registered, number ISRCTN10618300.. We assigned 1995 children to treatment in 14 intervention clusters and 1477 in 14 control clusters, and we analysed 1857 and 1354 children, respectively. Cluster-adjusted treatment failure rates by day 6 were significantly reduced in the intervention clusters (165 [9%] vs 241 [18%], risk difference -8·9%, 95% CI -12·4 to -5·4). Further adjustment for baseline covariates made little difference (-7·3%, -10·1 to -4·5). Two deaths were reported in the control clusters and one in the intervention cluster. Most of the risk reduction was in the occurrence of fever and lower chest indrawing on day 3 (-6·7%, -10·0 to -3·3). Adverse events were diarrhoea (n=4) and skin rash (n=1) in the intervention clusters and diarrhoea (n=3) in the control clusters.. Community case management could result in a standardised treatment for children with severe pneumonia, reduce delay in treatment initiation, and reduce the costs for families and health-care systems.. United States Agency for International Development (USAID).

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Case Management; Child, Preschool; Cluster Analysis; Community Health Workers; Female; Humans; Infant; Male; Pakistan; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is a leading cause of illness and death in young children. Interventions to improve case management of pneumonia are needed.. Our objective was to measure the effect of zinc supplementation in children with pneumonia in a population in which zinc deficiency is common.. In a double-blind, placebo-controlled clinical trial, children aged 2-35 mo with severe (n = 149) or nonsevere (n = 2479) pneumonia defined according to criteria established by the World Health Organization were randomly assigned to receive zinc (10 mg for children aged 2-11 mo, 20 mg for children aged > or =12 mo) or placebo daily for 14 d as an adjuvant to antibiotics. The primary outcomes were treatment failure, defined as a need for change in antibiotics or hospitalization, and time to recovery from pneumonia.. One of 5 children did not respond adequately to antibiotic treatment; the odds ratios between zinc and placebo groups for treatment failure were 0.95 (95% CI: 0.78, 1.2) for nonsevere pneumonia and 0.97 (95% CI: 0.42, 2.2) for severe pneumonia. There was no difference in time to recovery between zinc and placebo groups for nonsevere (median: 2 d; hazard ratio: 1.0; 95% CI: 0.96, 1.1) or severe (median: 4 d; hazard ratio: 1.1; 95% CI: 0.79, 1.5) pneumonia. Regurgitation or vomiting < or =15 min after supplementation was observed more frequently among children in the zinc group than among those in the placebo group during the supplementation period (37% compared with 13%; odds ratio: 0.25; 95% CI: 0.20, 0.30).. Adjuvant treatment with zinc neither reduced the risk of treatment failure nor accelerated recovery in episodes of nonsevere or severe pneumonia. This trial was registered at clinicaltrials.gov as NCT00148733.

Topics: Anti-Bacterial Agents; C-Reactive Protein; Child, Preschool; Double-Blind Method; Female; Hemoglobins; Humans; Infant; Male; Nepal; Oximetry; Pneumonia; Respiration; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Zinc

This cluster randomized, open labeled trial was conducted to compare the effectiveness of 3 days of oral amoxycillin and 5 days of co-trimoxazole treatment in terms of clinical failure in children with World Health Organization (WHO) defined non-severe pneumonia in primary health centers in rural India. Participants were children aged 2-59 months with WHO defined non-severe pneumonia, with or without wheeze, who were accessible to follow up. From seven primary health centers in each arm, 2009 cases were randomized, 993 and 1016 in treatment with amoxycillin and co-trimoxazole, respectively. Fever was present in 1247 (62.1%) and wheeze in 443 (22.1%). There was good adherence and low loss to follow-up. Clinical failure on amoxycillin and co-trimoxazole on intention to treat analysis was 137 and 97, respectively (absolute difference = 0.04, 95% confidence interval: - 0.035-0.12). We conclude that there was no difference in effectiveness of oral co-trimoxazole or amoxycillin in treating non-severe pneumonia.

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Child, Preschool; Drug Administration Schedule; Female; Humans; India; Infant; Male; Pneumonia; Rural Population; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Cotrimoxazole prophylaxis reduces morbidity and mortality in HIV-1-infected children, but mechanisms for these benefits are unclear.. CHAP was a randomized trial comparing cotrimoxazole prophylaxis with placebo in HIV-infected children in Zambia where background bacterial resistance to cotrimoxazole is high. We compared causes of mortality and hospital admissions, and antibiotic use between randomized groups.. Of 534 children (median age, 4.4 years; 32% 1-2 years), 186 died and 166 had one or more hospital admissions not ending in death. Cotrimoxazole prophylaxis was associated with lower mortality, both outside hospital (P = 0.01) and following hospital admission (P = 0.005). The largest excess of hospital deaths in the placebo group was from respiratory infections [22/56 (39%) placebo versus 10/35 (29%) cotrimoxazole]. By 2 years, the cumulative probability of dying in hospital from a serious bacterial infection (predominantly pneumonia) was 7% on cotrimoxazole and 12% on placebo (P = 0.08). There was a trend towards lower admission rates for serious bacterial infections in the cotrimoxazole group (19.1 per 100 child-years at risk versus 28.5 in the placebo group, P = 0.09). Despite less total follow-up due to higher mortality, more antibiotics (particularly penicillin) were prescribed in the placebo group in year one [6083 compared to 4972 days in the cotrimoxazole group (P = 0.05)].. Cotrimoxazole prophylaxis appears to mainly reduce death and hospital admissions from respiratory infections, supported further by lower rates of antibiotic prescribing. As such infections occur at high CD4 cell counts and are common in Africa, the role of continuing cotrimoxazole prophylaxis after starting antiretroviral therapy requires investigation.

Topics: Anti-Infective Agents; Antitubercular Agents; Cause of Death; CD4 Lymphocyte Count; Child; Child, Preschool; Disease Progression; Drug Resistance, Bacterial; Empyema; HIV; HIV Infections; Hospital Mortality; Hospitalization; Humans; Infant; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination; Zambia

Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. However, changing to alternative antimicrobial agents, such as amoxicillin, is costly. We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus double dosage for treating non-severe pneumonia in children.. A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community health programmes. A total of 1143 children aged 2-59 months with non-severe pneumonia were randomly allocated to receive 4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body weight orally twice-daily for 5 days Treatment failure occurred when a child required a change of therapy, died or was lost to follow-up. Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours after enrollment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower than at the time of enrollment).. The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double dose. Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10; 95% confidence interval = 0.87-1.37). Using multivariate analysis we found that treatment was more likely to fail in children who were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics previously (P = 0.002), those whose respiratory rate was > or =20 breaths/minute above the age-specific cut-off point (P = 0.006), and those from urban areas (P = 0.042).. Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia. Close follow-up of patients is essential to prevent worsening of disease. Definitions of clinical failure need to be more specific. Surveillance in both rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes.

Topics: Child, Preschool; Double-Blind Method; Female; Humans; Infant; Male; Outpatient Clinics, Hospital; Pakistan; Pneumonia; Rural Health; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Health

To assess the efficacy and safety of two different dosages of cotrimoxazole (CTX) in prophylaxis in HIV-positive new smear-positive pulmonary tuberculosis (TB) patients in Blantyre, Malawi.. Randomized, double-blind trial using 480 and 960 mg of CTX given to new TB patients, who were followed up until the end of the tuberculosis treatment. The primary outcome was survival. The outcome in the two groups was also compared with an unselected cohort of similar patients registered in Zomba, Malawi in 1995 and new smear-positive patients registered in the National Tuberculosis Programme in 1999. The secondary outcome was the occurrence of (opportunistic) events, especially bacterial pneumonia.. There were no statistically significant differences in mortality and bacterial pneumonia between the groups receiving the two different dosages. The case fatality rate at the end of the tuberculosis treatment was 15.4% in the 480 mg group and 14.0% in the 960 mg group. This was lower than the case fatality rate in the Zomba cohort (19.2%, P = 0.10) and lower than the case fatality rate in the national programme (21.0%, P < 0.001). CTX was well tolerated. Compliance was fair.. CTX prophylaxis may have a beneficial effect on mortality and morbidity in HIV-infected smear-positive tuberculosis patients in Malawi. The efficacy of both dosages is not significantly different. The intervention is cheap and easy to implement. These results would support implementation of CTX in this patient group until better strategies are available or evidence is convincingly presented to suggest that its benefit is marginal.

Topics: Adolescent; Adult; Antitubercular Agents; Double-Blind Method; Drug Administration Schedule; Female; HIV Infections; Humans; Malawi; Male; Middle Aged; Patient Compliance; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

To compare the clinical efficacy of twice daily oral co-trimoxazole with twice daily oral amoxicillin for treatment of childhood pneumonia.. Randomised controlled, double blind, multicentre study in outpatient departments of seven hospitals and in one community health service. A total of 1471 children (aged 2-59 months) with non-severe pneumonia were randomly assigned to 25 mg/kg amoxicillin (n = 730) or 4 mg/kg trimethoprim plus 20 mg/kg sulphamethoxazole (co-trimoxazole) (n = 741). Both medicines were given orally twice daily for five days.. Data from 1459 children were analysed: 725 were randomised to amoxicillin and 734 to co-trimoxazole. Treatment failure in the amoxicillin group was 16.1% compared to 18.9% in the co-trimoxazole group. Multivariate analysis showed that treatment failure was more likely in infants who had history of difficult breathing or those who had been ill for more than three days before presentation.. Both amoxicillin and co-trimoxazole were equally effective in non-severe pneumonia. Good follow up of patients is essential to prevent worsening of illness.

Topics: Amoxicillin; Anti-Infective Agents; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Male; Pakistan; Penicillins; Pneumonia; Statistics as Topic; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Children in developing countries who present with malnutrition often have infections, particularly pneumonia, at the time of presentation. We evaluated the initial antibiotic management of 144 Gambian children who presented for the first time with malnutrition and who had clinical or radiologic evidence of pneumonia. They were enrolled in a double blind trial of trimethoprim-sulfamethoxazole vs. chloramphenicol. Most children in the study underwent detailed investigations of bacterial and viral etiology as part of another study. The study drug was administered for a week along with oral metronidazole, vitamins and standardized nutritional therapy. Treatment failure was defined as the need for change to parenteral antibiotics during treatment, failure to respond to a week of treatment with the study drug or relapse during the following 2 weeks. There were no differences between the treatment groups in the clinical indicators of severity, etiology or radiologic findings. Thirty-three children were excluded from the analysis because of tuberculosis, inappropriate enrollment or inadequate follow-up. Of the 111 children remaining, 32 (16 in each arm of the study) failed treatment. Clinical failure was not related to in vitro antimicrobial resistance in the 20 cases in which invasive bacterial isolates were obtained. Those who failed treatment were more likely to have had lower chest wall indrawing and positive bacterial cultures than those who were successfully treated. In an area with infrequent antimicrobial resistance of common respiratory pathogens, oral chloramphenicol and trimethoprim-sulfamethoxazole were equally effective in the initial management of malnourished children with community-acquired pneumonia.

Topics: Administration, Oral; Anti-Infective Agents; Child, Preschool; Chloramphenicol; Community-Acquired Infections; Developing Countries; Double-Blind Method; Female; Gambia; Humans; Infant; Male; Nutrition Disorders; Pneumonia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In a community-based intervention trial to reduce childhood mortality from pneumonia the intervention area included 58 villages (6176 children aged 0-4 years) and the control area 44 villages (3947 children) in Gadchiroli, India. The interventions included mass education about childhood pneumonia and case-management of pneumonia by paramedics, village health workers, and traditional birth attendants (TBAs) who were trained to recognise childhood pneumonia and treat it with co-trimoxazole. Parents sought treatment, and coverage was 76% without active case-detection efforts. The case-fatality rate among the 612 cases treated by health workers was 0.8%, compared with 13.5% in the control area. After a year of intervention pneumonia-specific childhood mortality was significantly lower in the intervention than in the control area (8.1 vs 17.5 deaths per 1000 children under 5 years); the difference between the areas was greatest in children under 1 year. The differences in infant mortality (89 vs 121 per 1000) and total under-5 mortality (28.5 vs 40.7 per 1000) were highly significant. Mortality from other causes remained similar in the two areas but neonatal mortality due to birth injury and prematurity was significantly lower in the intervention area, presumably owing to the combination of better maternal and neonatal care by the TBAs trained in the project and the availability of treatment for pneumonia. The cost of co-trimoxazole was US $0.025 per child per year ($2.64 per child saved).

Topics: Administration, Oral; Age Factors; Birth Injuries; Cause of Death; Child, Preschool; Community Health Services; Community Health Workers; Drug Administration Schedule; Evaluation Studies as Topic; Female; Health Education; Hemorrhage; Humans; India; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Pilot Projects; Pneumonia; Rural Health; Sampling Studies; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of danofloxacin, a novel third generation fluoroquinolone, was assessed in the treatment of pneumonia in housed calves on three farms in the FDR and Italy. Seventy three calves with clinical signs of acute pneumonia and rectal temperatures greater than 40 degrees C were treated with danofloxacin at a dose rate of 1.25 mg/kg for three or five days depending on response to treatment. The response in these calves was compared to that obtained in 77 calves treated with trimethoprim/sulpha. The clinical response achieved with danofloxacin was superior to that achieved with trimethoprim/sulpha and significantly fewer calves which received danofloxacin required five days treatment. Pasteurella haemolytica and, or P. multocida were isolated from the majority of calves prior to treatment. All isolates were sensitive to danofloxacin and over 90 percent were sensitive to trimethoprim/sulpha.

Topics: 4-Quinolones; Animals; Anti-Infective Agents; Cattle; Cattle Diseases; Fluoroquinolones; Pasteurella Infections; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

Reported are the results of a randomized trial of sulfamethoxazole + trimethoprim versus procaine penicillin for the outpatient treatment of pneumonia in 614 children aged 3 months to 12 years at primary health care clinics in Chitungwiza, a large town near Harare, Zimbabwe. Diagnosis and treatment were carried out by nurses, without medical supervision. The presence of lower respiratory tract infection that required antibiotics was diagnosed on the basis of a recent history of a cough and the presence of a respiratory rate of greater than 50 per minute. Patients were followed up by a research nurse with minimal drop-out losses. Referred children were examined and assessed by a doctor at the Chitungwiza General Hospital. Of the study children, 65 (11%) were referred to hospital, but only 8 (1.3%) had pneumonia that required a change in the treatment (5 in the sulfamethoxazole + trimethoprim group and 3 in the procaine penicillin group). There were no significant differences in outcome between the two treatment groups. One child, who had evidence of infection with human immunodeficiency virus (HIV), died. Sulfamethoxazole + trimethoprim and procaine penicillin were highly and equally effective for the outpatient treatment of children who had been clinically diagnosed to have pneumonia by primary health care workers.

Topics: Ambulatory Care; Child; Child, Preschool; Female; Humans; Infant; Male; Penicillin G; Penicillin G Procaine; Pneumonia; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Zimbabwe

134 Gambian children under 5 years of age with severe pneumonia (as defined by the World Health Organisation classification of acute respiratory infections) were given either oral co-trimoxazole for 5 days, or a single intramuscular dose of fortified procaine penicillin and 5 days of oral ampicillin. At 2 weeks, there was no significant difference in outcome between the two groups. Co-trimoxazole is much less expensive than ampicillin or procaine penicillin, requires only twice-daily administration, and can be given by health-care staff with little training. The results support the use of co-trimoxazole as the antibiotic of first choice in outpatient management of young children with pneumonia in developing countries.

Topics: Ambulatory Care; Ampicillin; Anti-Infective Agents; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Female; Humans; Infant; Male; Penicillin G; Penicillin G Procaine; Pneumonia; Sulfamethoxazole; Trimethoprim; 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

In a comparative study of infection prophylaxis, patients with acute leukemia receiving remission induction therapy were assigned either no prophylaxis, sulfamethoxazole and trimethoprim, ketoconazole, or the combination of sulfamethoxazole and trimethoprim and ketoconazole. Both sulfamethoxazole and trimethoprim and the combination of sulfamethoxazole and trimethoprim and ketoconazole substantially reduced the overall incidence of infection consequent to a marked decrease in bacterial infection. However, sulfamethoxazole and trimethoprim were associated with an increased rate of fungal infection, while ketoconazole decreased this complication. No form of prophylaxis reduced infectious mortality or increased the complete remission rate. However, because of its effect in reducing infectious morbidity, we conclude that patients with acute leukemia receiving remission induction treatment should be given antibacterial and antifungal prophylaxis.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Drug Combinations; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Humans; Ketoconazole; Leukemia; Middle Aged; Mycoses; Pneumonia; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND Stenotrophomonas maltophilia has the propensity to cause a plethora of opportunistic infections in humans owing to biofilm formation and antibiotic resistance. It is often seen as a co-organism along with Pseudomonas aeruginosa. CASE REPORT A 70-year-old woman with several co-morbidities presented reporting hypoglycemia and dyspnea. An imaging study of the chest was suggestive of deterioration of pneumonia, with increased opacities. Initial respiratory cultures were negative, while subsequent repeat cultures revealed the growth of Stenotrophomonas maltophilia susceptible to trimethoprim plus sulfamethoxazole and levofloxacin. The patient had a poor prognosis and eventually died despite appropriate measures. CONCLUSIONS A decline in the clinical status of a patient such as ours makes it hard to quickly diagnose this organism correctly. Physicians should thus be cautious of Stenotrophomonas maltophilia-induced infection and more emphasis should be placed on appropriate treatment due to the emerging risk of antibiotic resistance.

Topics: Aged; Anti-Bacterial Agents; Fatal Outcome; Female; Gram-Negative Bacterial Infections; Heart Arrest; Humans; Levofloxacin; Opportunistic Infections; Pneumonia; Sepsis; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Good's syndrome (GS) is a rare, adult-onset combined B cell and T cell immunodeficiency with an associated thymoma. These patients have an increased risk of bacterial, fungal, viral and opportunistic infections. This report describes a 75-year-old female patient who presented with a full body rash and an anterior mediastinal mass. She underwent a biopsy of her rash and mass, which revealed erythema multiforme and WHO Type A thymoma, respectively. During her hospitalisation, she was also found to have oropharyngeal candidiasis, methicillin-susceptible

Topics: Aged; Anti-Bacterial Agents; Cardiac Rehabilitation; Erythema Multiforme; Fatal Outcome; Female; Fluid Therapy; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Pneumonia; Shock, Septic; Staphylococcal Infections; Thymoma; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND We investigated the factors affecting antibiotic resistance in the intensive care unit (ICU)-related hospital-acquired infections caused by Klebsiella pneumoniae (KP-HAI) and the effects of antibiotics used for high-level antibiotic resistance on patient survival. MATERIAL AND METHODS This retrospective study was performed at the adult ICU of Bezmialem Vakif University Hospital. Patients who were followed up between 01 January 2012 and 31 May 2017 were evaluated. Each KP strain was categorized according to resistance patterns and analyzed. The efficiency of antibiotic therapy for highly-resistant KP-HAI was determined by patients' lifespans. RESULTS We evaluated 208 patients. With the prior use of carbapenem, antibiotics against resistant Gram-positives, and tigecycline, it was observed that the resistance rate of the infectious agents had a significant increase. As the resistance category increases, a significant decrease was seen in the survival time. We observed that if the treatment combination included trimethoprim-sulfamethoxazole, the survival time became significantly longer, and tigecycline-carbapenem-colistin and tigecycline-carbapenem combination patients showed significantly shorter survival times. CONCLUSIONS When the resistance increases, delays will occur in starting suitable and effective antibiotic treatment, with increased sepsis frequency and higher mortality rates. Trimethoprim-sulfamethoxazole can be an efficient alternative to extend survival time in trimethoprim-sulfamethoxazole-susceptible KP infections that have extensive drug resistance.

Topics: Adult; Aged; Anti-Bacterial Agents; Carbapenems; Colistin; Cross Infection; Drug Resistance, Bacterial; Drug Resistance, Microbial; Female; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Pneumonia; Retrospective Studies; Risk Factors; Survival Rate; Tigecycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Clindamycin; Combined Modality Therapy; Doxycycline; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Pneumonia; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia (SM) has emerged as an important nosocomial pathogen with high morbidity and mortality. Because of its unique antimicrobial susceptibility pattern, appropriate antimicrobial therapy for SM bacteremia is still challenging, especially in immunocompromised patients. The present study was performed to assess clinical predictors of SM bacteremia in adult patients with hematologic malignancy. From 2006 through 2016, a case-control study was performed at a tertiary-care hospital. Case patients were defined as SM bacteremia in patients with hematologic malignancy. Date- and location-matched controls were selected from among patients with gram-negative bacteremia (GNB) other than SM. A total of 118 cases of SM bacteremia were identified and compared to 118 controls. While pneumonia was the most common source of SM bacteremia, centralline-associated infection was most common in the controls. The overall 30-day mortality rate of cases with SM bacteremia was significantly higher than that of the controls (61.0 and 32.2%, respectively; P < 0.001). A multivariable analysis showed that polymicrobial infection, previous SM isolation, the number of antibiotics previously used ≥ 3, and breakthrough bacteremia during carbapenem therapy were significantly associated with SM bacteremia (all P < 0.01). Previous use of trimethoprim/sulfamethoxazole (TMP/SMX) was negatively association with SM bacteremia (P = 0.002). Our data suggest that SM is becoming a significant pathogen in patients with hematologic malignancy. Several clinical predictors of SM bacteremia can be used for appropriate antimicrobial therapy in hematologic patients with suspected GNB.

Topics: Adult; Aged; Anti-Bacterial Agents; Carbapenems; Case-Control Studies; Cross Infection; Female; Gram-Negative Bacterial Infections; Hematologic Neoplasms; Humans; Immunocompromised Host; Male; Middle Aged; Multivariate Analysis; Pneumonia; Prognosis; Stenotrophomonas maltophilia; Survival Analysis; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to describe the clinical characteristics and antimicrobial patterns of Stenotrophomonas maltophilia bloodstream infections (BSI) and pneumonia episodes in patients with cancer.. Patients with S. maltophilia BSI or pneumonia admitted from 1 Jan. 2000 to 31 Dec. 2016 were identified at the Instituto Nacional de Cancerología (INCan), a tertiary-care oncology hospital in Mexico City.. During the study period, there were 171 isolates identified. The mean age of the whole group was 46.9 ± 17.4 years; 99 (57.9%) were women. There were 95 BSI: 64 ambulatory catheter-related BSI (CRBSI), 20 nosocomial CRBSI, and 11 secondary BSI. Mortality was higher in nosocomial CRBSI (40%) vs. that in ambulatory CRBSI (7.8%) (p = 0.001). There were 76 pneumonia episodes; all were nosocomial acquired; 46 (60.5%) ventilator-associated. From all the group, nine strains (5.2%) were resistant to sulfamethoxazole/trimethoprim/(SMX/TMP). At the first month, 54 patients (31.6%) have died, 38 due to pneumonia (70%) and 16 due to BSI (30%, p < 0.001). Multivariate analysis showed that removal of central venous catheter was associated with a favorable outcome in patients with bacteremia. For patients with pneumonia, age ≥ 65 years and inappropriate antimicrobial treatment were risk factors associated with 30-day mortality.. S. maltophilia related with ambulatory CRBSI have a better prognosis than other sources of BSI. Older patients with pneumonia who do not receive appropriate antibiotics have higher mortality. SMX/TMP is still the antibiotic of choice.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Female; Gram-Negative Bacterial Infections; Hospitalization; Humans; Male; Mexico; Middle Aged; Mortality; Neoplasms; Pneumonia; Prognosis; Risk Factors; Stenotrophomonas maltophilia; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amputation, Surgical; Animals; Anti-Bacterial Agents; Delayed Diagnosis; Disease Susceptibility; Fingers; Fishes; Hand Dermatoses; Humans; Levofloxacin; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Pneumonia; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Aged, 80 and over; Anti-Bacterial Agents; Antifungal Agents; Burkholderia cepacia; Candida glabrata; Fluconazole; Humans; Lung; Male; Pneumonia; Radiography, Thoracic; Trimethoprim, Sulfamethoxazole Drug Combination

Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery.. We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2-59 months) diagnosed by community health workers with fast-breathing pneumonia using WHO integrated community case management (iCCM) guidelines. Children were followed at days 5 and 14 with a clinical assessment of recovery. We conducted bivariate and multivariable logistic regression for the association between treatment of fast-breathing pneumonia and recovery, adjusting for potential confounders.. We followed up 847 children, of whom 78 (9%) had not been given antibiotics (non-treatment). Non-treatment cases had higher baseline rates of diarrhoea, non-severe hypoxaemia and fever. Non-recovery (persistence or worsening of symptoms) was 13% and 23% at day 5 in those who did receive and those who did not receive co-trimoxazole. Non-recovery, when defined as worsening of symptoms only, at day 5 was 7% in treatment and 10% in non-treatment cases. For both definitions, combined co-trimoxazole and lumefantrine-artemether (LA) treatment trended towards protection (adjusted OR (aOR) 0.28; 95% CI 0.12 to 0.68/aOR 0.29; 95% CI 0.08 to 1.01).. We found that children who did not receive co-trimoxazole treatment had worse clinical outcomes; malaria co-diagnosis and treatment also play a significant role in non-recovery. Further research into non-treatment of fast-breathing pneumonia, using a pragmatic approach with consideration for malaria co-diagnosis and HIV status is needed to guide refinement of community treatment algorithms in this region.

Topics: Anti-Bacterial Agents; Child, Preschool; Coinfection; Community Health Services; Female; Humans; Infant; Logistic Models; Malaria; Malawi; Male; Multivariate Analysis; Pneumonia; Prospective Studies; Rural Population; Trimethoprim, Sulfamethoxazole Drug Combination; Withholding Treatment

We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Empyema, Pleural; Hemangiosarcoma; Humans; Imipenem; Immunocompromised Host; Male; Middle Aged; Multiple Organ Failure; Nocardia; Nocardia Infections; Pneumonia; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa.. We prospectively followed a cohort of children (2-59 months), diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO) integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping.. We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted). The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47) and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26) were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56).. This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

Topics: Administration, Oral; Anti-Bacterial Agents; Child, Preschool; Cohort Studies; Community Health Workers; Humans; Infant; Malawi; Models, Biological; Patient Compliance; Pneumonia; Prospective Studies; Respiration; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

A 50-year-old man was treated with trimethoprim-sulfamethoxazole (TMP-SMX) for acute arthritis of his right big toe. Within a few days, he developed dyspnoea, hypoxaemia and diffuse pulmonary infiltrates. Symptoms improved with discontinuation of the antibiotic but worsened again with its reintroduction. An open lung biopsy was performed. We describe the workup performed and the factors that pointed to a final diagnosis of TMP-SMX-related pulmonary toxicity in the form of acute fibrinous organising pneumonia.

Topics: Alveolar Epithelial Cells; Anti-Bacterial Agents; Arthritis; Biopsy; Fibrin; Humans; Lung; Male; Middle Aged; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

Torsades de pointes (TdP) is a rapid, polymorphic and usually self-terminating ventricular tachycardia associated with the long QT syndrome. Many drugs may cause prolongation of QT interval and be the trigger for TdP occurrence. We present the case of 52-year-old male who was treated with clarithromycin due to bilateral atypical pneumonia. However, on the fourth day of hospitalization he deteriorated, developed pulmonary edema and short cardiac arrest. After successful resuscitation, unfortunately amiodarone and co-trimoxazole were given causing the arrhythmic storm which required many defibrillations. The case highlights the importance of careful QT measurement, appropriate TdP treatment and difficulties resulting from the patient's disagreement for invasive treatment. We think, that knowledge of drug-induced long QT syndrome and its consequences should be widely spread not only in cardiologists, but also in others doctors.

Topics: Amiodarone; Anti-Arrhythmia Agents; Clarithromycin; Drug Therapy, Combination; Electrocardiography; Heart Arrest; Humans; Long QT Syndrome; Male; Middle Aged; Pneumonia; Pulmonary Edema; Torsades de Pointes; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a patient with disseminated toxoplasmosis who presented with cervical lymphadenopathies and pneumonia. Although the infection was successfully treated with co-trimoxazole, the patient developed reactive macrophage activation syndrome (rMAS). To our knowledge, this is the first reported case of rMAS triggered by toxoplasmosis in the medical literature.

Topics: Anti-Infective Agents; Female; Humans; Lymphatic Diseases; Macrophage Activation Syndrome; Middle Aged; Neck; Pneumonia; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Animals; Bronchoalveolar Lavage Fluid; Fatal Outcome; Humans; Male; Pneumonia; Strongyloides stercoralis; Strongyloidiasis; Trimethoprim, Sulfamethoxazole Drug Combination

There is strong research evidence that community case management (CCM) programs can significantly reduce mortality. There is less evidence, however, on how to implement CCM effectively either from research or regular program data. We analyzed monitoring data from CCM programs supported by the International Rescue Committee (IRC), covering over 2 million treatments provided from 2004 to 2011 in six countries by 12,181 community health workers (CHWs). Our analysis yielded several findings of direct relevance to planners and managers. CCM programs seem to increase access to treatment, although diarrhea coverage remains low. In one country, the size of the catchment area was correlated with use, and increased supervision was temporally and strongly associated with improved quality. Planners should use routine data to guide CCM program planning. Programs should treat all three conditions from the outset. Other priorities should include use of diarrhea treatment and insurance of adequate supervision.

Topics: Africa South of the Sahara; Amoxicillin; Case Management; Community Health Services; Community Health Workers; Databases, Factual; Diarrhea; Electrolytes; Government Programs; Health Facilities; Health Policy; Humans; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination; Zinc

Nocardiosis is a life-threatening infection that affects the lungs, skin, and central nervous system, particularly in immune-compromised patients. We report a case of disseminated nocardiosis with pneumonia, brain abscesses, meningitis, and thyroiditis, for an individual with recent steroid therapy. Recovery was uneventful with a 4-month course of sulfamethoxazole-trimethoprim.

Topics: Aged; Brain Abscess; Female; Humans; Meningitis; Nocardia; Nocardia Infections; Pneumonia; Thyroid Diseases; Thyroiditis; Trimethoprim, Sulfamethoxazole Drug Combination

Pulmonary nocardiosis is a rare respiratory infection whose diagnosis can easily be missed because there are no suggestive symptoms. Nocardiosis is typically regarded as an opportunistic infection, but one-third of infected patients are immunocompetent. We present two situations of pulmonary lesions in immunocompetent people. A CT-guided percutaneous transthoracic needle biopsy was performed in both cases but was not informative. Suppurative inflammation had developed as a complication of the procedure in the biopsy site after 1-2 weeks. Pus was aspirated and culture showed Nocardia spp. Therefore we hypothesize that the pulmonary lesion was caused initially by Nocardia which had subsequently disseminated to the chest wall after the biopsy. Treatment with trimethoprim/sulfamethoxazole was undertaken. Resolution of the disease was evaluated according to the clinical symptoms and radiological resolution after 6 months therapy.

Topics: Aged; Anti-Bacterial Agents; Biopsy, Needle; Female; Humans; Lung; Male; Nocardia; Nocardia Infections; Pleural Effusion; Pneumonia; Pseudomonas Infections; Radiography, Interventional; Skin; Solitary Pulmonary Nodule; Thoracic Wall; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. In the case of SSTIs, alternative treatment of these infections should be considered, especially when the bacterial pathogen is unknown. Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs.

Topics: Adolescent; Anti-Bacterial Agents; Cellulitis; Communicable Diseases, Emerging; Community-Acquired Infections; Diagnostic Errors; Humans; Immunoglobulins, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Pneumonia; Recurrence; Scarlet Fever; Sepsis; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

We report a patient who presented 6 months after orthotopic liver transplantation (OLT) with fever, dyspnea, and pulmonary infiltrates with biopsy-confirmed Pneumocystis jiroveci infection associated with a process of bronchiolitis obliterans organizing pneumonia (BOOP). We present this second case of BOOP associated with P. carinii pneumonia after OLT to highlight the risk of such disease combination in all transplant patients as well as discuss the protective effect of post-transplant prednisolone with trimethoprim-sulfamethoxazole prophylaxis and the possible duration of prophylaxis.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Biopsy; Cryptogenic Organizing Pneumonia; Diagnosis, Differential; Drug Therapy, Combination; Hepatitis, Alcoholic; Humans; Liver Transplantation; Lung; Male; Middle Aged; Pneumocystis carinii; Pneumonia; Pneumonia, Pneumocystis; Prednisolone; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

Reports of high levels of antimicrobial resistance to cotrimoxazole in children with non-severe pneumonia (NSP) have prompted calls for a change to amoxicillin in the therapeutic guidelines at the first-level health care facility (FLHF). FLHFs lack data about the use of World Health Organization (WHO) acute respiratory infection (ARI) standard case management (SCM).. To apply ARI SCM guidelines at the FLHF, assess clinical outcome of NSP with oral cotrimoxazole and determine the risk factors influencing treatment outcome.. Health care workers (HCWs) at 14 health centres managed children aged 2-59 months with NSP according to ARI SCM guidelines. The primary outcome was treatment failure, including change of antibiotic therapy and loss to follow-up.. Of 949 children enrolled, 110 (11.6%) failed therapy with oral cotrimoxazole. Clinical failure was significantly higher among children presenting with a fast respiratory rate of > or = 15 breaths/min above normal for age and wheezing on examination.. To treat children with NSP at the FLHF, oral cotrimoxazole is an acceptable treatment choice in view of the efficacy, cost and ease of use. In children with wheezing and signs of pneumonia, the decision to use antibiotic therapy should be made after a trial of bronchodilator therapy.

Topics: Administration, Oral; Analysis of Variance; Anti-Infective Agents; Case Management; Child, Preschool; Female; Follow-Up Studies; Guideline Adherence; Health Care Surveys; Health Facilities; Humans; Infant; Male; Pakistan; Pneumonia; Practice Guidelines as Topic; Respiration; Risk Factors; Sample Size; Severity of Illness Index; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

To estimate the incidence and epidemiological characteristics of invasive pneumococcal disease (IPD) in children<5 years of age living in a rural area of southern Mozambique.. As part of the clinical management of children admitted to Manhiça District Hospital, prospective surveillance for invasive bacterial disease was conducted from June 2001 to May 2003. The level of antibiotic resistance of the isolates was also analysed.. Pneumococcus was the most commonly isolated bacterium, accounting for 212 episodes. The estimated crude incidence rate of IPD in the study area among children<5 years of age was 416/100,000 per child-year at risk. The youngest age group (<3 months) had the highest incidence (779/100,000). Cases were detected during both rainy and dry seasons. The most common clinical diagnosis was pneumonia, made in 146/212 (69%) of the episodes of IPD. The overall case fatality rate was 10%, being highest among children with pneumococcal meningitis (5/9=56%). Pneumococcal isolates were highly susceptible to penicillin (86% susceptible and 14% with intermediate resistance) and chloramphenicol (98% susceptible). In contrast, up to 37% of the isolates tested were non-susceptible to cotrimoxazole.. Incidence rates of IPD and associated mortality shown in this study highlight the need for pneumococcal vaccines in rural Africa, which must be effective in infants and young children.

Topics: Age Distribution; Anti-Infective Agents; Child, Preschool; Chloramphenicol; Drug Resistance, Bacterial; Female; Humans; Incidence; Infant; Male; Meningitis, Pneumococcal; Mozambique; Penicillins; Pneumococcal Infections; Pneumonia; Population Surveillance; Prospective Studies; Risk Factors; Rural Health; Sex Distribution; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia farcinica has been reported as an increasingly frequent cause of localized and disseminated infections in immunocompromised patients in recent years, but N. farcinica bacteraemia remains a rare finding. Here, the case is described of a 68-year-old man with end-stage renal disease and idiopathic thrombocytopenia purpura treated with steroid therapy who developed disseminated infection (bacteraemia, multilobar pneumonia and brain abscesses) due to N. farcinica. The isolate was confirmed by partial sequencing analysis of the 16S rRNA gene. The patient recovered after prolonged trimethoprim-sulfamethoxazole therapy with no recurrence in over 1 year.

Topics: Aged; Bacteremia; Brain Abscess; DNA, Bacterial; DNA, Ribosomal; Humans; Male; Nocardia; Nocardia Infections; Pneumonia; Purpura, Thrombocytopenic, Idiopathic; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Steroids; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia

Hyperinsulinemic hypoglycemia associated with trimethoprim-sulfamethoxazole (TMP-SMX) has generally been reported in adults who had renal impairment or in patients with AIDS using high dose TMP-SMX. We present a 5 month-old infant with immunodeficiency due to major histocompatibility complex class II expression defect, developing hypoglycemic convulsion on the third day of high dose TMP-SMX administration. High insulin and C-peptide levels were documented at the time of hypoglycemia. To overcome hypoglycemia while TMP-SMX tapered off, diazoxide was administered which resolved hypoglycemia in 2 months.

Topics: Blood Glucose; C-Peptide; Diazoxide; Drug Administration Schedule; Female; Gene Expression; Genes, MHC Class II; Glucose; Histocompatibility Antigens Class II; Hospitalization; Humans; Hyperinsulinism; Hypoglycemia; Immunologic Deficiency Syndromes; Infant; Infusions, Intravenous; Pneumonia; Seizures; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A case of post-transplantation pneumonia due to Candida krusei is reported. A 42-year-old man was admitted 28 days after heart transplantation with cough, pleuritic pain and fever. A chest computed tomograph showed multiple alveolar infiltrates bilaterally. He received broad-spectrum antibiotics, fluconazole for oral candidiasis, and cotrimoxazole for possible Pneumocystis carinii. A short-lived period of improvement was followed by respiratory failure. Cultures of bronchial washings grew C. krusei and C. albicans. The infection was documented by histology and culture obtained by transthoracic aspiration. Treatment with amphotericin B was initiated, but the patient died. Histology and culture of a pulmonary specimen, obtained immediately post mortem, further documented the infection with C. krusei.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Candida; Candidiasis; Fatal Outcome; Fluconazole; Heart Transplantation; Humans; Immunocompromised Host; Male; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

To use qualitative research to develop a complementary set of job aids to improve adherence to cotrimoxazole for childhood pneumonia and to improve provider-client counseling.. Qualitative research on existing knowledge and practices of parents and providers using key informant interviews, focus groups, clinic observation, and home visits. A workshop of local stakeholders produced messages and job aids for health care workers and parents that included counseling cards and posters for providers, and medication envelopes with educational messages for mothers. Draft mock-ups were tested, modified, and re-tested before final production and distribution.. Boboye District, Niger.. Clinic health care workers, mothers of children with pneumonia, and key informants.. A complementary set of counseling tools, or job aids, was designed based on consensus developed during the workshop, leading to greater buy-in and local support.. Behavior change communication theory and qualitative research can be applied to the design of key messages on adherence to an antibiotic regimen and corresponding job aids for both parents and health care workers. This approach generates enthusiastic support from local participants.

Topics: Anti-Infective Agents; Counseling; Drug Labeling; Drug Resistance, Microbial; Focus Groups; Guideline Adherence; Health Personnel; Health Services Research; Humans; Interviews as Topic; Niger; Patient Compliance; Patient Education as Topic; Pneumonia; Qualitative Research; Teaching Materials; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the WHO (World Health Organization) algorithm for management of respiratory tract infection (RTI) in HIV-1-infected adults and determine risk factors associated with RTI, we enrolled a cohort of 380 HIV-1-seropositive adults prospectively followed for incident RTI at an outpatient clinic in Nairobi, Kenya. RTI was diagnosed when patients presented with history of worsening or persistent cough. Patients were treated with ampicillin, or antituberculosis therapy when clinically indicated, as first-line therapy and with trimethoprim/sulfamethoxazole as second-line therapy. Five hundred ninety-seven episodes of RTI were diagnosed: 177 of pneumonia and 420 of bronchitis. The WHO RTI algorithm was used for 401 (95%) episodes of bronchitis and 151 (85%) episodes of pneumonia (p <.001). Three percent of bronchitis cases versus 32% of pneumonia cases failed to respond to first-or second-line treatment (p <.0001). Being widowed (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.0-4.4), less than 8 years of education (adjusted OR = 2.5, CI: 1.5 - 4.1), and CD4 count < 200 cells/microl (adjusted OR = 2.4, CI: 1.4-3.9) were risk factors for pneumonia. A high percentage of patients (32%) with pneumonia required a change in treatment from that recommended by the WHO guidelines. Randomized trials should be performed to determine more appropriate treatment strategies in HIV-1-infected individuals.

Topics: Adult; AIDS-Related Opportunistic Infections; Algorithms; Ampicillin; Bronchitis; Cohort Studies; Female; HIV-1; Humans; Kenya; Male; Odds Ratio; Pneumonia; Prospective Studies; Respiratory Tract Infections; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; World Health Organization

Two hundred eleven adults with human immunodeficiency virus (HIV) infection hospitalized for community-acquired pneumonia, including Pneumocystis carinii pneumonia (PCP; patients), and 192 matched HIV-infected hospitalized patients without pneumonia (controls) were interviewed to determine risk factors for pneumonia. Multivariate logistic regression showed that patients were less likely than controls to have used trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.12-0.41) and more likely to have been hospitalized previously with pneumonia (OR, 6.25; CI, 3.40-11.5). Patients were also more likely than controls to have gardened (OR, 2.24; CI, 1.00-5.02) and to have camped or hiked (OR, 4.95; CI, 1.31-18.7), but stratified analysis by etiologic agent showed this association only for PCP. These findings reconfirm the efficacy of TMP-SMZ in preventing community-acquired pneumonia. In addition, hospitalization for pneumonia might represent a missed opportunity to encourage HIV-infected patients to enter into regular medical care and to adhere to prescribed antiretroviral and prophylaxis medications.

Topics: Adult; Community-Acquired Infections; Female; HIV Infections; Humans; Logistic Models; Male; Middle Aged; Pneumonia; Pneumonia, Pneumocystis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To assist the Central African Republic (CAR) develop national guidelines for treating children with pneumonia, a survey was conducted to determine antimicrobial resistance rates of nasopharyngeal isolates of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI). Secondary purposes of the survey were to identify risk factors associated with carriage of a resistant isolate and to compare the survey methods of including only children with pneumonia vs. including all ill children.. A cross-sectional survey of 371 ill children was conducted at 2 outpatient clinics in Bangui, CAR.. In all 272 SP isolates and 73 HI isolates were cultured. SP resistance rates to penicillin, trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline and chloramphenicol were 8.8, 6.3, 42.3 and 9.2%, respectively. All penicillin-resistant SP isolates were intermediately resistant. HI resistance rates to ampicillin, TMP-SMX and chloramphenicol were 1.4, 12.3 and 0%, respectively. The most common SP serotypes/groups were 19, 14, 6 and 1; 49% of HI isolates were type b. History of antimicrobial use in the previous 7 days was the only factor associated with carriage of a resistant isolate. Resistance rates were similar among ill children regardless of whether they had pneumonia.. Resistance rates were low for antimicrobials recommended by the World Health Organization for children with pneumonia. We recommended TMP-SMX as the first line treatment for pneumonia in CAR because of its low cost, ease of dosing and activity against malaria.

Topics: Carrier State; Central African Republic; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Microbial; Haemophilus influenzae; Humans; Infant; Microbial Sensitivity Tests; Nasopharynx; Pneumonia; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To determine whether foals with pneumonia that were treated with erythromycin, alone or in combination with rifampin or gentamicin, had a higher risk of developing adverse effects, compared with foals treated with trimethoprim-sulfamethoxazole (TMS), penicillin G procaine (PGP), or a combination of TMS and PGP (control foals).. Retrospective study.. 143 foals < 240 days old.. Information on age, sex, breed, primary drug treatment, total days of treatment with the primary drug, and whether the foal developed diarrhea, hyperthermia, or respiratory distress was obtained from the medical records. Relative risk (RR) and attributable risk (AR) were calculated to compare risk of adverse reactions between foals treated with erythromycin and control foals.. Only 3 (4.3%) control foals developed diarrhea; none developed hyperthermia or respiratory distress. Foals treated with erythromycin had an 8-fold risk (RR, 8.3) of developing diarrhea, compared with control foals, and increased risks of hyperthermia (AR, 25%) and respiratory distress (AR, 15%).. Results suggest that use of erythromycin to treat foals with pneumonia was associated with an increased risk of diarrhea, hyperthermia, and respiratory distress, compared with use of TMS or PGP.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Diarrhea; Drug Therapy, Combination; Erythromycin; Female; Fever; Gentamicins; Horse Diseases; Horses; Male; Penicillin G Procaine; Penicillins; Pneumonia; Respiratory Insufficiency; Retrospective Studies; Rifampin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Evaluation of digitized chest x-ray for the detection of pulmonary infiltrations in bone marrow transplant patients during aplasia.. Digitized chest x-rays of 40 patients (21 female, 19 male) with "Fever of unknown origin" (FUO) were evaluated concerning radiological signs of pulmonary infiltrations and correlated to clinical findings, blood chemistry, microbiology and bronchoscopy. Additionally, an individual risk profile was established.. In 11/40 patients pulmonary infiltrations were detected in digitized chest x-rays (group 1). 10/11 developed an infectious pulmonary infiltration. 29/40 patients developed no pulmonary infiltration (group 2). When fever increased for the first time (initial chest x-ray) a sensitivity, specificity, positive and negative predictive value of 46%, 86%, 56%, 81% and for the chest x-rays in progress of 61%, 79% 68% and 73% was found. C-reactive protein and temperature increase occurred statistically significantly earlier (p < 0.05) in group 1 compared to group 2. The average latency of digital chest x-rays in comparison to c-reactive protein and temperature increase was 6 days. The incidence of risk factors was significantly higher in group 1 in comparison to group 2 (p < 0.05).. Digitized chest x-rays are not a reliable method for primary detection of pulmonary infiltrations after bone marrow transplantation. Individual risk factors have to be taken into consideration to indicate further diagnostic methods such as computed tomography at an earlier time.

Topics: Adult; Anemia, Aplastic; Anti-Infective Agents; Antibiotic Prophylaxis; Antifungal Agents; Bone Marrow Transplantation; Diagnosis, Differential; Female; Fluconazole; Humans; Lung Diseases; Lung Diseases, Fungal; Male; Middle Aged; Ofloxacin; Pneumonia; Prospective Studies; Radiographic Image Enhancement; Radiography, Thoracic; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the epidemiologic, clinical, radiologic, laboratory and treatment characteristics of acute pneumonia and its association with mortality in HIV-infected children.. Data were collected during a trial of intravenous immunoglobulin (IVIG) for infection prophylaxis (1988 to 1991); CD4+ percentage was measured and HIV RNA was assessed on stored sera collected at baseline and every 3 months. Mortality was recorded during the trial and updated through 1996. All reported physician-diagnosed pneumonia episodes underwent blinded review for trial endpoint classification as acute (new radiologic findings and presence of clinical symptoms) or nonacute.. On blinded clinical trial endpoint review of all reported pneumonia episodes (n = 281), only 47% were classified as acute. One hundred thirty-one episodes of acute pneumonia were reported in 93 children (47 in 31 IVIG and 84 in 62 placebo patients, P < 0.01). The incidence of acute pneumonia was 24 episodes per 100 patient years. Findings associated with an acute bacterial process were uncommon (leukocytosis > or =15000/mm3 in 21% and fever > or =103 degrees F in 32% of episodes). Multiple acute episodes occurred in 34% of the children and were associated with increased risk of mortality in a univariate analysis (risk ratio, 2.1; 95% confidence interval, 1.3 to 3.4, P = 0.002), but in a multivariate model only baseline HIV RNA copy number and CD4+ percentage remained independently associated with mortality (relative risk, 2.0 and 1.4, respectively, P < 0.001).. Acute pneumonia was a common occurrence in HIV-infected children and was associated with long term mortality risk. Multiple episodes of acute pneumonia likely represent a marker of progressive disease and immunologic dysfunction rather than being causally associated with increased long term mortality.

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Bacterial Infections; CD4 Lymphocyte Count; Child; Child, Preschool; Clinical Trials as Topic; Female; HIV Infections; Humans; Immunoglobulins, Intravenous; Infant; Male; Pneumonia; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Vaccines; beta-Lactam Resistance; Ceftazidime; Humans; Penicillin Resistance; Penicillins; Pneumonia; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Treatment of childhood pneumonia in developing countries requires knowledge of susceptibility patterns for Streptococcus pneumoniae and Haemophilus influenzae. Between October 1991 and April 1993, a surveillance survey of antimicrobial resistance was performed at two fever hospitals in Egypt; nasopharyngeal swab and blood specimens obtained from 1,635 children with pneumonia were cultured for these organisms. Susceptibility testing of these organisms was performed. At least one of these organisms was isolated from nasopharyngeal swab specimens from 73% of the children; 3.7% of blood cultures were positive. For S. pneumoniae strains, 70.9% of nasopharyngeal isolates were calculated to be susceptible to penicillin vs. 77.6% of blood isolates; the percentages of isolates susceptible to co-trimoxazole were 73.0% and 75.0%, respectively. For H. influenzae strains, 93.0% of nasopharyngeal isolates were calculated to be susceptible to ampicillin vs. 100% of blood isolates; the percentages of isolates susceptible to co-trimoxazole were 84.9% and 100%, respectively. Although most S. pneumoniae and H. influenzae strains associated with childhood pneumonia in Cairo were susceptible to penicillins and co-trimoxazole, antimicrobial resistance did not occur.

Topics: Ampicillin; Ampicillin Resistance; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Egypt; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumonia; Streptococcus pneumoniae; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Anti-Bacterial Agents; Cross Infection; Humans; Lung; Nursing Homes; Pneumonia; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; AIDS-Related Opportunistic Infections; Cost-Benefit Analysis; Pneumocystis; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

This study, which aimed to assess the results of three different regimens in the treatment of pneumonia, was carried out at the Pediatric Outpatient Department of Capa Children's Hospital in Istanbul on 151 patients aged between 4 months and 14 years. The first group (n = 46) received co-trimoxazole orally for 10 days and the second group (n = 63) procaine penicillin G in intramuscularly for 10 days. Benzathin penicillin G combined with procaine penicillin G was given to the third group (n = 42) as a single dose intramuscularly. While the best results were obtained with penicillin procaine G, no statistically significant difference was found between this regimen and co-trimoxazole therapy (chi 2 = 0.305023 P = 0.5). We suggest that co-trimoxazole is easy to administer and cost effective in the ambulatory treatment of pneumonia in children.

Topics: Administration, Oral; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Injections, Intramuscular; Male; Penicillin G; Penicillin G Benzathine; Pneumonia; Procaine; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

During a community-based study in four rural villages in Pakistan, 617 cases of acute respiratory infections (ARI) in children younger than 5 years of age were assessed, classified and managed according to the WHO ARI case management guidelines. Of these, 509 (82.5%) had 'cough and cold' without clinical evidence of pneumonia, 95 pneumonia, two severe pneumonia and 11 otitis media. Of the 509 without clinical evidence of pneumonia but with cough and cold, 491 (96.5%) were successfully treated without antibiotics and only 18 (3.5%) of these children needed antimicrobial therapy on follow-up. Of the 95 cases of pneumonia, 87 (91.4%) showed a satisfactory clinical response to oral cotrimoxazole and only eight (8.4%) required a change of antibiotic.

Topics: Acute Disease; Amoxicillin; Ampicillin; Child, Preschool; Common Cold; Drug Combinations; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Pakistan; Pneumonia; Practice Guidelines as Topic; Respiratory Tract Infections; Rural Health; Trimethoprim, Sulfamethoxazole Drug Combination; World Health Organization

Topics: AIDS-Related Opportunistic Infections; Humans; Male; Meningitis, Bacterial; Middle Aged; Nocardia asteroides; Nocardia Infections; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

A 65 year old man was admitted with segmental consolidation of the left upper lobe after having stayed in a hotel for 2 days. He deteriorated rapidly on conventional antibiotic therapy and required ventilatory support. Acinetobacter calcoaceticus var. anitratus was grown from the sputum and blood cultures, which was treated with a combination of anti-pseudomonal agent, aminoglycoside and cotrimoxazole. He made a slow but remarkable recovery from the pneumonia. Acinetobacter is a rare potentially fatal cause of community-acquired pneumonia.

Topics: Acinetobacter Infections; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Community-Acquired Infections; Drug Therapy, Combination; Humans; Male; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

Neonatal pneumonia kills about two million children a year worldwide. The World Health Organisation recommends hospitalisation of all cases of pneumonia in the first two months of infancy. In a field trial of community based management of childhood pneumonia in Gadchiroli, India, neonatal pneumonia contributed more than half of the pneumonia deaths. Parents refused referral even when advised therefore community based health workers and traditional birth attendants managed cases of neonatal pneumonia with co-trimoxazole. Case fatality was 15% (10/65) in all cases and 6% (3/52) in cases without high risk or referral indications. Case fatality in 56 babies aged 30-59 days treated for pneumonia was zero. During the two years of the trial, pneumonia specific mortality rate in the intervention area was 40% less in the neonates and about 80% less in the second month and rest of infancy compared with the control area. Pneumonia in the second month of infancy and uncomplicated cases of neonatal pneumonia can be safely and effectively managed in the community using co-trimoxazole.

Topics: Community Health Services; Community Health Workers; Feasibility Studies; Humans; India; Infant; Infant, Newborn; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

A case is reported of rapid onset concomitant pulmonary infection with Nocardia and Aspergillus fumigatus in a patient six weeks after the institution of immunosuppressive therapy for renal vasculitis. Pulmonary lesions completely resolved on treatment with a combination of imipenem, cotrimoxazole and a prolonged course of itraconazole.

Topics: Adult; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cyclophosphamide; Drug Therapy, Combination; Humans; IgA Vasculitis; Imipenem; Immunocompromised Host; Itraconazole; Ketoconazole; Kidney Failure, Chronic; Lung; Lung Diseases, Fungal; Male; Nocardia Infections; Pneumonia; Prednisolone; Radiography; Renal Dialysis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amikacin; Ciprofloxacin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Pleural Effusion; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a survey over a 21-year period of the incidence and risk of occurrence of episodes of pneumonia and pneumonitis in children treated for solid tumours and leukaemia. One hundred episodes occurred amongst 219 patients, seven of which were associated with death. Focal opacification on the chest radiograph was more common than diffuse opacification. Patients with leukaemia had a significantly higher rate of occurrence of pneumonia and pneumonitis during the periods of induction and maintenance compared with the off-treatment period, and during the relapse period compared with the period of maintenance. Patients with solid tumours had a significantly higher rate of occurrence during treatment compared to the off-treatment period. The rate of occurrence on treatment was the same in patients with solid tumours and acute leukaemia. Children with malignancy have a high incidence of pneumonia and pneumonitis and death is rare if the patient does not have terminal malignant disease.

Topics: Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bacterial Infections; Child; Clinical Protocols; Daunorubicin; Humans; Immunocompromised Host; Leukemia; Methotrexate; Neoplasms; Opportunistic Infections; Pneumonia; Pneumonia, Viral; Prednisolone; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

A patient is described in whom there developed a pulmonary infiltrate and constrictive pericarditis caused by a combined Actinomyces and Actinobacillus actinomycetemcomitans infection, presumably originating from his poor dentition. The diagnosis was only made following repeated thoracotomy. After surgery, long-term treatment with antibiotics led to complete clinical recovery. None the less, some months later he was found to have a brain abscess which resolved during a further course of antibiotics. The variable clinical picture of actinomycosis is discussed, as well as the role of other bacteria frequently associated with actinomycotic infection, in particular Actinobacillus actinomycetemcomitans. The therapeutic implications are described.

Topics: Actinobacillus Infections; Actinomyces; Actinomycosis; Adult; Aggregatibacter actinomycetemcomitans; Brain Abscess; Humans; Male; Pericarditis, Constrictive; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of Nocardia asteroides pneumonia and subsequent brain abscess in an immunocompromised host.. Private, community, teaching hospital.. A man readmitted to the hospital for a third time with a fatal brain abscess, after responding to (misdirected) therapy in previous admissions.. Treatment with cefuroxime, erythromycin, trimethoprim/sulfamethoxazole at different times.. Patient's condition deteriorated and he died after one month of intravenous trimethoprim/sulfamethoxazole therapy.. Because it is an infection of the immunocompromised host, it may be considered an AIDS-defining illness. Several other similar cases have been reported in the literature.

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain Abscess; Humans; Immunocompromised Host; Male; Nocardia asteroides; Nocardia Infections; Pneumonia; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Drug Therapy, Combination; Humans; Opportunistic Infections; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination; Zalcitabine; Zidovudine

Ninety consecutive first-time fiberoptic bronchoscopies (FB) were performed on HIV-infected patients with pulmonary symptoms and radiographic evidence of active pneumonitis. Microbiological data were analysed for acute and long-term prognostic significance. 56/90 (63%) patients had one type of microbiological agent recovered from FB, 22/90 (24%) patients had more types recovered, and 12/90 (13%) patients had no types recovered. Nine patients (10%) died during the acute episode of pneumonia. A prognostic factor of a fatal outcome of the acute episode of pneumonia was concurrent multiple pulmonary infections (p = 0.002), mainly ascribed to patients with Pneumocystis carinii pneumonia (PCP) and concomitant bacterial pneumonia (p = 0.003). Specific microbiological findings at FB did not influence long-term survival of patients, and, when omitting patients who died during the acute episode of pneumonia (n = 9), no difference in survival was observed between patients with a) no agent, b) one type of agent or c) more types of agents recovered from FB. Only non-pulmonary parameters such as CD4-count, haemoglobin and age were found to be prognostic parameters. Thus, increased attention should be paid to co-pathogens presenting in HIV-infected patients with pulmonary infection and appropriate therapy instituted.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Aged; Bronchoscopy; Cryptosporidiosis; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Pentamidine; Pneumonia; Pneumonia, Pneumocystis; Risk Factors; Survival Analysis; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.

Topics: Administration, Oral; Age Factors; Cause of Death; Child, Preschool; Chloramphenicol; Community Health Workers; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Nepal; Pneumonia; Program Evaluation; Rural Health; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases with concomitant pulmonary nocardiosis and Pneumocystis carinii pneumonia are described. The first patient developed pneumonia 3 months after heart transplantation while undergoing standard immunosuppressive therapy with cyclosporin, azathioprine and prednisone. The second patient was treated with chemotherapy and subsequent radiotherapy of the mediastinum for a malignant epithelial tumour. He also received prednisone for paraneoplastic dermatomyositis. Chest X-rays of both patients showed a bilateral interstitial pattern and broncho-alveolar lavage revealed P. carinii. Additional dense and localised pulmonary infiltrates led to suspicion of a further infectious agent, namely, Nocardia asteroides, which was isolated from both patients. Since nocardiosis calls for prolonged treatment, extensive diagnostic measures are needed for its early detection.

Topics: Heart Transplantation; Humans; Immunosuppression Therapy; Male; Mediastinal Neoplasms; Middle Aged; Nocardia asteroides; Nocardia Infections; Pneumonia; Pneumonia, Pneumocystis; Sulfadiazine; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Drug Therapy, Combination; Enoxacin; Humans; Male; Mycobacterium Infections, Nontuberculous; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

Pneumonia is the most common infectious disease necessitating hospitalization of elderly patients. A number of misconceptions exist regarding the clinical and radiological features of pneumonia in elderly patients. Early recognition and appropriate therapy can reduce morbidity and enhance survival. This article explores the manifestations of pneumonia in the elderly, as well as the diagnostic approach and contemporary therapy.

Topics: Aged; Anti-Bacterial Agents; Cefuroxime; Erythromycin; Hospitalization; Humans; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

The pharmacokinetics of co-trimoxazole in serum, bronchoalveolar lavage-fluid (BAL-fluid) and alveolar macrophages (AM) of guinea pigs receiving sulphamethoxazole (100 mg/kg) and trimethoprim (20 mg/kg) were studied. HPLC showed that peak co-trimoxazole levels were obtained in serum at 30 min, in BAL-fluid at 1 h and in AM at 3 h. A comparison between mean concentrations in serum, BAL-fluid and AM showed a six-fold higher concentration of trimethoprim in cells than in serum, but only 0.25-fold of sulphamethoxazole. The BAL-fluid/serum ratio was four to ten times higher for trimethoprim than for sulphamethoxazole (0.6-to-one-fold). Sulphamethoxazole/trimethoprim ratios (30 min, 1 and 3 h) were lower in BAL-fluid (4.9 +/- 0.5) and in AM (1.4 +/- 0.5) than in serum (30.7 +/- 1.6). The influence of co-trimoxazole in vitro on microbicidal capacities (superoxide anion and hydrogen peroxide generations), immunoregulation (production of interleukin 1) and pro-inflammatory agent production (tumour necrosis factor) of guinea pigs' AM was also studied. No significant effect of co-trimoxazole on superoxide anion and hydrogen peroxide generations, or on interleukin 1 and TNF production, was demonstrable.

Topics: Animals; Bronchoalveolar Lavage Fluid; Chromatography, High Pressure Liquid; Guinea Pigs; Hydrogen Peroxide; Immunity; In Vitro Techniques; Interleukin-1; Kinetics; Macrophages; Male; Pneumonia; Pulmonary Alveoli; Superoxides; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha

Topics: Acinetobacter Infections; Blood; Drug Combinations; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Sulfamethoxazole; Tobramycin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In order to investigate the frequency of the emergence of resistance during treatment, 1,403 episodes of lower respiratory infection were studied in a General Hospital with three departments of Chest Medicine in a period of four years. In 650 episodes the pathogen was isolated and in 82 of those failure of therapy was accompanied by emergence of resistance to the agent used. Factors associated with this phenomenon were: intensive care, tracheostomy, involvement of Pseudomonas aeruginosa, Enterobacter spp., Serratia marcescens, Staphylococcus aureus or Acinetobacter calcoaceticus, use of antipseudomonas penicillins, cefotaxime (especially when used in P. aeruginosa infections) and co-trimoxazole and monotherapy as opposed to appropriate combination therapy in patients with nosocomial pneumonia.

Topics: Acinetobacter; Anti-Bacterial Agents; Bacteria; Cefotaxime; Cross Infection; Drug Combinations; Drug Therapy, Combination; Drug Utilization; Enterobacteriaceae; Humans; Intensive Care Units; Penicillin Resistance; Penicillins; Pneumonia; Pseudomonas aeruginosa; Respiratory Tract Infections; Retrospective Studies; Staphylococcus aureus; Sulfamethoxazole; Tracheotomy; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Child; Child, Preschool; Drug Combinations; Granulomatous Disease, Chronic; Humans; Pneumonia; Pseudomonas; Pseudomonas Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Branhamella catarrhalis has recently been recognized as an opportunistic respiratory pathogen. We tested 10 isolates recovered from patients with documented B. catarrhalis pneumonia and 15 colonizing isolates for their susceptibility to 19 antimicrobial agents and for their ability to produce beta-lactamase. Eight of ten disease isolates and 12 of 15 colonizing isolates produced a detectable beta-lactamase. The isolates that were negative for beta-lactamase were susceptible to all agents tested, including penicillin G. Although all strains were found to be susceptible to the majority of the newer agents by broth dilution testing, the most active new semisynthetic penicillin was azlocillin (MIC that inhibited 90% of strains, 0.5 micrograms/ml), and moxalactam had the greatest potency among the cephalosporins (MIC that inhibited 90% of strains, 0.06 micrograms/ml). Members of the first- and second-generation cephalosporins had only moderate activity. All disease isolates were susceptible to the aminoglycosides and to trimethoprim-sulfamethoxazole and resistant to vancomycin. The antibiotic susceptibilities of the disease isolates were not different from those of the colonizing strains. The results of standardized disk diffusion testing did not correlate well with those of dilution testing for penicillin or ampicillin. However, disk diffusion testing did predict susceptibility adequately for the remainder of the antibiotics tested.

Topics: Aminoglycosides; Anti-Bacterial Agents; beta-Lactamases; Cephalosporins; Drug Combinations; Humans; Microbial Sensitivity Tests; Neisseria; Penicillins; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A man who, only in 1979 and on a few occasions, had homosexual contacts, transmitted AIDS virus HTLV-III in 1980 and 1981 to two previously healthy women who did not belong to any AIDS risk group. One of them now has an early form of AIDS, while the other died of AIDS in its full form and her child, born in 1983, has fairly far progressed early symptoms of AIDS. Serum antibodies against HTLV-III were demonstrated in all four subjects.

Topics: Acquired Immunodeficiency Syndrome; Adult; Bone Marrow Examination; Bronchi; Candidiasis; Cerebral Infarction; Child, Preschool; Coitus; Demyelinating Diseases; Drug Combinations; Female; Humans; Ketoconazole; Male; Pneumocystis; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Several antimicrobial agents were evaluated for activity against experimental Legionella micdadei pneumonia in guinea pigs. Erythromycin, rifampin, doxycycline, and sulfamethoxazole-trimethoprim produced significant reductions in mortality. Penicillin, cefazolin, cefoxitin, chloramphenicol, and gentamicin were not efficacious even though, at the doses administered, the peak concentrations of these agents in serum substantially exceeded their MICs for the test strain. It is suggested that the poor performance of the latter group of agents resulted from poor penetration into cells in which L. micdadei was multiplying.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoxitin; Chloramphenicol; Doxycycline; Drug Combinations; Erythromycin; Gentamicins; Guinea Pigs; Kinetics; Legionella; Male; Penicillin G; Pneumonia; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical and laboratory characteristics of 27 patients during an outbreak of pneumonia due to Legionella micdadei were reviewed. These patients were compared with a group of 46 patients who had other causes of nosocomial acquired pneumonia. Patients with pneumonia due to L micdadei typically had nosocomial acquisition of the disease and were immunosuppressed. Symptoms, physical findings, and laboratory tests were nonspecific; however, patients with pneumonia due to L micdadei had an increased frequency of pleuritic pain in the chest, dyspnea, cough, and changes in mental status compared to the nosocomial group. Direct fluorescent antibody staining and culture of sputum and other respiratory secretions established the diagnosis of infection with L micdadei. Unusual features included dual infections in three patients and pulmonary cavitation in five patients. Therapy with erythromycin, when instituted early, decreased mortality. Trimethoprim-sulfamethoxazole, used as alternative therapy in patients with persistent infection, was also curative. Because of the high mortality associated with a delay in diagnosis, it is important to consider the diagnosis of pneumonia due to L micdadei in immunosuppressed patients.

Topics: Adult; Aged; Bacterial Infections; Cross Infection; Diagnosis, Differential; Drug Combinations; Erythromycin; Female; Humans; Immunosuppression Therapy; Legionella; Male; Middle Aged; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Once a Hemophilus influenzae isolate is identified as the cause of a respiratory tract infection in an adult, it should be tested for beta-lactamase production, ie, for ampicillin resistance. The incidence of ampicillin-resistant strains of H influenzae is increasing. The Centers for Disease Control in Atlanta estimates an average incidence nationwide of 18% to 22%; the rate varies considerably from community to community. Thus, practitioners should be aware of the ampicillin-resistance rate in their community and should keep this rate in mind especially when treating patients empirically. Patients with H influenzae infections who are acutely ill, who fail to respond to ampicillin, or who are known to have an ampicillin-resistant infection on the basis of laboratory findings should receive therapy designed to combat ampicillin-resistant strains.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Bronchitis; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Penicillin Resistance; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The increasing incidence of Haemophilus influenzae resistant to ampicillin has clinical implications not only for pediatricians but also for family physicians, because the bacterium is recognized more frequently as the etiologic agent for diseases in adults as well as in young children. Ampicillin is no longer the automatic choice for treatment of patients thought to have life-threatening H influenzae disease, and empiric treatment of otitis media must be reexamined. Chloramphenicol, as well as ampicillin, must be considered for the treatment of meningitis and other serious systemic H influenzae infections. Once the infective organism has been isolated and tested for resistance, ampicillin alone may be used if indicated or desired. Alternatives to ampicillin for middle ear infection are trimethoprim-sulfamethoxazole (Bactrim, Septra), erythromycin-sulfonamide (Pediazole), and cefaclor (Ceclor). Isolation and susceptibility tests are seldom done because they necessitate tympanocentesis.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Otitis Media; Penicillin Resistance; Pneumonia; Respiratory Tract Infections; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Drug Combinations; Follow-Up Studies; Humans; Penicillins; Pneumonia; Streptomycin; Sulfamethoxazole; Sulfanilamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 29 year old woman with polymyositis treated with azathioprine presented with pneumonia. Rising serum antibody titres have confirmed a diagnosis of legionnaires' disease. Infection with Legionella pneumophila must now be considered in New Zealand when patients present with pneumonia and severe pyrexia, especially if they show known risk factors.

Topics: Adult; Antibodies, Bacterial; Azathioprine; Drug Combinations; Female; Humans; Legionnaires' Disease; Myositis; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination