trimethoprim--sulfamethoxazole-drug-combination and Sinusitis

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

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

TREATMENT OF SINUSITIS: For both acute rhinosinusitis in patients with no past history where S. pneumoniae and H. influenzae are the main causal agents, or recurrent sinusitis in a chronic background where anaerobic bacteria are increasingly implicated, pristinamycin is one of the rare compounds which can be expected to be effective and is a treatment of choice for an empirical strategy. LOWER RESPIRATORY TRACT INFECTIONS: Besides high-risk subjects with non-microbiologically proven bronchial infection, where enterobacteriaceae could involve a pristinamycin is a useful alternative to the conventional strategy (i.e.: amoxicillin, macrolides and cotrimoxazole) in the treatment of LRT infection.

Topics: Acute Disease; Adult; Amoxicillin; Bronchial Diseases; Bronchitis; Female; Humans; Macrolides; Male; Respiratory Tract Infections; Rhinitis; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Virginiamycin

The clinical presentation, radiological and laboratory evaluation, treatment, and risk factors of sinusitis in a cohort of 376 human immunodeficiency virus (HIV)-infected children from a placebo-controlled clinical trial of intravenous immunoglobulin (IVIG) as prophylaxis for infections were examined. Ninety-five episodes of sinusitis were described in 60 patients; one-third of the patients had two or more episodes. Sinusitis episodes were commonly associated with nonspecific, chronic symptoms (67.4%, persistent nasal discharge; 54.7%, nocturnal or persistent cough), whereas symptoms more specific to acute sinusitis were less frequent (17.9%, headache or facial pain; 9.5%, periorbital swelling; 25.3%, temperature of > or = 102 degrees F; 9%, total white blood cell count of > or = 15,000/mm3). The sinuses primarily involved were the maxillary sinus (85.9%) and the ethmoidal sinus (42.3%); 36% of episodes involved two or more sinuses. Preceding respiratory infections did not appear to increase the risk of sinusitis, and CD4+ lymphocyte counts in children with and without sinusitis did not differ. Neither monthly IVIG prophylaxis nor three times weekly trimethoprimsulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia decreased the risk of sinusitis. Sinusitis in HIV-infected children is most often subacute and recurrent. Evaluations of new modalities for prophylaxis for sinusitis are needed.

Topics: AIDS-Related Opportunistic Infections; Anti-Infective Agents; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Female; Humans; Immunoglobulins, Intravenous; Infant; Male; Recurrence; Risk Factors; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

The need for antimicrobials in the treatment of subacute sinusitis was evaluated in 96 afebrile children who were prescribed antimicrobial (amoxicillin, amoxicillin clavulanate potassium, or trimethoprim-sulfamethoxazole) or no antimicrobial medication in addition to a decongestant and saline nasal spray for 3 weeks.. Response was determined by complete clearing of the initial radiologic abnormalities or in the case of mucosal thickening, by a significant decrease in thickness to < 6 mm within the maxillary sinuses associated with improvement of the clinical signs and symptoms of sinusitis. If there was evidence of partial clearing by radiograph, the same therapy was continued for another 3 weeks. Nonresponders demonstrated no change or worsening of clinical and radiologic findings.. Sixty-seven of the 96 subjects (70%) responded: 58 (87%) in 3 weeks and 9 (13%) in 6 weeks. Fifty-five of the responders were in the antimicrobial treatment group, and 12 were prescribed no antimicrobial medication. Twenty-nine of the 96 subjects (30%) did not respond to treatment; 22 received an antimicrobial and seven received no antimicrobial medication.. The number of responders and nonresponders was similar in the antimicrobial- and nonantimicrobial-treated groups (p = NS), and no single antimicrobial medication demonstrated greater treatment effectiveness.

Topics: Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Male; Paranasal Sinuses; Radiography; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Amoxicillin; Ampicillin; Drug Combinations; Female; Humans; Male; Middle Aged; Otitis Media; Pivampicillin; Random Allocation; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Seven-day courses of either 200 mg pivmecillinam plus 250 mg pivampicillin or co-trimoxazole (800 mg sulphamethoxazole plus 160 mg trimethoprim) given twice daily were compared in a multi-centre general practice study in 318 patients with signs and symptoms of upper or lower respiratory tract infection. Patients were stratified into four diagnostic groups (sinusitis, otitis media, throat infections, and acute bronchitis) and randomly allocated to treatment within these groups. Assessments at Day 7 showed that both treatments were equally effective clinically, 154 (91%) patients in the pivmecillinam plus pivampicillin group showing clinical cure or improvement and 142 (88%) patients in the co-trimoxazole group. Side-effects were reported by 19 (11.9%) patients in the pivmecillinam plus pivampicillin group and by 24 (15.8%) patients in the co-trimoxazole group. Two patients in the pivmecillinam plus pivampicillin group and 4 patients in the co-trimoxazole group stopped treatment.

Topics: Adolescent; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Anti-Infective Agents; Bronchitis; Child; Clinical Trials as Topic; Drug Combinations; Family Practice; Female; Humans; Male; Middle Aged; Otitis Media; Pharyngitis; Pivampicillin; Random Allocation; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

127 outpatients, 78 with acute purulent sinusitis and 49 with acute tonsillitis, were treated for 7 days with a benzylpyrimidine -sulphonamide combination. In this double-blind and randomized study 59 patients received co- tetroxazine (100 mg tetroxoprim and 250 mg sulphadiazine) b.i.d., whilst the reference substance, co-trimoxazole (160 mg trimethoprim and 800 mg sulphamethoxazole) was given to the remaining 68 patients b.i.d. The test criteria were the therapeutic efficacy and both subjective and objective tolerance. An improvement in clinical symptoms and signs occurred in both conditions under each therapeutic regimen. Clinical therapeutic success was rated very good or good in 96.6% treated with co- tetroxazine and in 97.1% of patients treated with co-trimoxazole. In the former group therapy failed in 1 patient with sinusitis and in 1 with acute tonsillitis . In 98.3% of patients treated with co- tetroxazine the tolerance was very good or good, whilst the respective figure for co-trimoxazole was only 91.2%. 6 patients suffered from side effects ( gastric spasm, gastralgia , nausea, vomiting, diarrhoea) which were so severe in 2 cases that treatment had to be prematurely terminated. The generally good tolerance to both preparations was confirmed by the results of the laboratory investigations.

Topics: Acute Disease; Adult; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Pyrimidines; Sinusitis; Sulfadiazine; Sulfamethoxazole; Tonsillitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In a randomized double-blind study fifty-four patients suffering from acute maxillary sinusitis were treated for 10 days with daily doses of sulphadiazine/trimethoprim (1 g) and sulphamethoxazole/trimethoprim (1.92 g), respectively. The efficacy was evaluated clinically at two follow-up visits. X-ray investigations were performed at admission and after the therapy. Of thirty-nine patients finally evaluated, thirty-seven showed a favourable result. After 6-8 days of therapy there was significant difference in cure rates in favour of sulphadiazine/trimethoprim (p less than 0.05) while the outcome as evaluated after treatment was similar for both drugs.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Maxillary Sinus; Middle Aged; Random Allocation; Sinusitis; Sulfadiazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fluoroquinolones are used for conditions including sinusitis, bronchitis, and urinary tract infections. It has been suggested that exposure to fluoroquinolones for these conditions is associated with disability resulting from adverse events in 2 or more organ systems. The objectives were to: describe: 1) fluoroquinolone, azithromycin, and sulfamethoxazole / trimethoprim utilization for these infections; 2) the rate of disability associated with exposure to each of these antibiotic classes and adverse events in 2 or more system organ classes, and 3) compare outcome rates for each of the antibiotic classes.. This study was conducted using administrative data to mitigate the limitations of spontaneous reports. The sampling frame was a U.S. population with both medical and disability insurance, including patients with the above uncomplicated infections who were prescribed the antibiotics of interest. The primary outcome was an incident short-term disability claim associated with adverse events in 2 different organ systems within 120 days of exposure. A matched analysis was used to compare the outcome for patients receiving each of the drug classes.. After propensity score matching, there were 119,653 individuals in each of the exposure groups. There were 264 fluoroquinolone associated disability events and 243 azithromycin/ sulfamethoxazole associated disability events (relative risk =1.09 (95% CI: 0.92-1.30; calibrated p = 0.84)). The results were not significantly different from the null hypothesis of no difference between groups.. Comparative assessments are difficult to conduct in spontaneous reports. This examination of disability associated with adverse events in different system organ classes showed no difference between fluoroquinolones and azithromycin or sulfamethoxazole in administrative data.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Anti-Bacterial Agents; Azithromycin; Bronchitis; Drug Utilization; Female; Fluoroquinolones; Humans; Male; Middle Aged; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Trimethoprim/sulfamethoxazole has been suggested as a treatment option for chronic rhinosinusitis with purulence. This study aimed to assess the functional and endoscopic outcomes after a three-month course of low-dose trimethoprim/sulfamethoxazole.. A prospective study was performed, comprising patients referred to a tertiary care medical centre with a diagnosis of chronic rhinosinusitis with purulence. Trimethoprim/sulfamethoxazole was prescribed at 960 mg/day for three months. Sinonasal complaints and endoscopic findings were documented, and bacteriological data were compared.. Fifteen patients were included. Staphylococcus aureus was the most common bacterium cultured (86 per cent). Improvement in nasal function, as measured by the 22-item Sino-Nasal Outcome Test, was highly significant at three months (p < 0.0005). This improvement slightly decreased but remained significant at 6, 9 and 12 months. No side effects were noted. Endoscopic scores revealed similar and concordant improvements.. Long-term low-dose trimethoprim/sulfamethoxazole therapy seems to be a safe option for selected patients. Additional randomised multicentre studies remain necessary.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Cavity; Nasal Surgical Procedures; Prospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Time; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Anti-Bacterial Agents; Bordetella; Bordetella Infections; Child; Female; Humans; Immunocompromised Host; Maxillary Sinus; Microbial Sensitivity Tests; Sinusitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 5-year-old female had history of chronic foul smelling nasal discharge. Rhinoscopy showed greenish crusts lining the nasal cavities and inferior turbinates were shriveled significantly. Nasal cavity cultures of crusts by swab revealed Klebsiella ozaenae making the diagnosis of primary atrophic rhinosinusitis. After several unsuccessful treatment, we have decided to try sulfamethoxazole-trimethoprim prophylaxis and 1 year later there was a complete clinical improvement. There are many medical therapies and surgical options described, but none of them showed effective at long term. We present antibiotic prophylaxis as a viable alternative for long term control of the disease.

Topics: Anti-Bacterial Agents; Atrophy; Child, Preschool; Endoscopy; Female; Humans; Klebsiella Infections; Nasal Cavity; Rhinitis; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Turbinates

Despite their widespread use, antibiotics have not been shown to improve chronic rhinosinusitis (CRS) outcomes. We aimed to determine whether culture-inappropriate postoperative antibiotic therapy was associated with less quality-of-life (QOL) improvement following functional endoscopic sinus surgery (FESS).. This retrospective cohort study recruited 376 adult CRS patients undergoing FESS between October 1, 2007 to December 31, 2011. Patient demographics, comorbidities and medications were collected at baseline. Trimethoprim-sulfamethoxazole and clindamycin were administered for 2 weeks postoperatively. The antibiotic appropriateness was determined based on bacterial resistance profile of organisms identified during intraoperative culture. The QOL outcome was defined as change of 22-item Sinonasal Outcome Test scores from preoperative visit to 1-month, 3-month, and 6-month post-FESS. Clinically significant difference was defined as at least 0.5 standard deviations (SD) of baseline QOL score in the reference group. Mixed-effects regression models were performed.. Seven percent of patients (n = 27) had culture-inappropriate antibiotic therapy, and additional 5% (n = 19) had culture-specific antibiotic adjustment. Compared to patients with culture-appropriate antibiotics, patients with culture-inappropriate antibiotics had significantly less improvement of QOL from baseline to postoperative 1-month and 3-month follow-up where the difference became clinically significant; patients with antibiotic adjustment had more QOL improvement from baseline to 1-month follow-up, but their QOL worsened at 3-month follow-up, and these changes were not clinically significant. However, all effects washed out at 6-month follow-up with no significant differences.. Culture-inappropriate postoperative antibiotic therapy decreased short-term QOL improvement to a clinically meaningful level after FESS. Culture guided selection of antibiotics may improve short-term FESS outcome.

Topics: Adult; Antibiotic Prophylaxis; Chronic Disease; Clindamycin; Cohort Studies; Drug Resistance, Bacterial; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Paranasal Sinuses; Postoperative Period; Quality of Life; Retrospective Studies; Rhinitis; Sinusitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam.. Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term.. Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group.. Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Chronic Disease; Female; Humans; Macrolides; Male; Middle Aged; Rhinitis; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 29-year-old woman presented with multiple painful swelling with discharging sinuses over the scalp. Histopathological examination of the biopsy tissue was suggestive of actinomycotic mycetoma. Streptomyces spp. was isolated from blood culture. The patient was successfully treated with trimethoprim-sulfamethoxazole and crystalline penicillin. This case is reported because of the rare occurrence of bacteremia by Streptomyces spp. secondary to subcutaneous actinomycotic mycetoma. Moreover, an interesting association between successive two pregnancies and occurrence of mycetoma of the scalp was observed in this case.

Topics: Actinomycetales Infections; Adult; Animals; Anti-Bacterial Agents; Bacteremia; Blood; Female; Humans; Mycetoma; Penicillins; Sinusitis; Skin Diseases, Bacterial; Streptomyces; Trimethoprim, Sulfamethoxazole Drug Combination

Histiocytoid Sweet's syndrome is a recently described entity which has clinical features identical to typical Sweet's syndrome but is distinguished by a dermal cellular infiltrate composed not of mature neutrophils but of immature granulocytes. Herein, we report a case of bone marrow granulocytic maturation arrest and a histological histiocytoid Sweet's-like reaction pattern following trimethoprim-sulfamethoxazole therapy.

Topics: Adult; Anti-Infective Agents; Cell Differentiation; Female; Flow Cytometry; Histiocytosis; Humans; In Situ Hybridization; Neutrophils; Sinusitis; Sweet Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

The pathogenesis of fixed drug eruption (FDE) is still unknown. One of the most common associations of FDE is the use of sulfonamides. Cotrimoxazole (trimethoprim with sulfamethoxazole) is one of the most commonly prescribed sulfonamide drugs. Non-pigmenting FDE (NPFDE) is a a relatively rare condition and only a few cases have been reported. We describe a case of unilateral NPFDE in a 45-year-old man whose lesions were on his right leg and foot as well as his ipsilateral penile skin. Cotrimoxazole was suspected as the offending drug and its role was confirmed by an oral challenge test.

Topics: Anti-Bacterial Agents; Drug Eruptions; Humans; Male; Middle Aged; Recurrence; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of possible severe, life-threatening thrombocytopenia associated with trimethoprim/sulfamethoxazole (TMP/SMX) therapy.. A 54-year-old white woman received a 10-day course of TMP/SMX for treatment of chronic sinusitis. One day after finishing the course of TMP/SMX therapy, the presented to the emergency department because of the development of scattered petechiae on both hands and blood blisters in her mouth. On admission, her complete blood cell count results revealed a severely low platelet count of 2 x 10(3)/mm3. Other laboratory test results were normal, except for elevated blood glucose (nonfasting blood glucose). TMP/SMX was believed to be the most likely cause of thrombocytopenia. She was treated successfully with a transfusion of 2 units of platelets and oral prednisone. Her platelet count increased to 110 x 10(3)/mm3 4 days after discontinuation of TMP/SMX. She was discharged on hospital day 5. On follow-up (2 wk after hospital discharge), her platelet count was normal (351 x 10(3)/mm3).. TMP/SMX has been implicated as a cause of thrombocytopenia, which is defined as platelet count < 150 x 10(3)/mm3. Although it is uncommon, spontaneous severe bleeding may occur when platelet count decreases to < or = 10 x 10(3)/mm3. Thrombocytopenia associated with TMP/SMX appears to be an immune-mediated process resulting in platelet destruction by drug-dependent platelet antibodies. Treatment of thrombocytopenia associated with TMP/SMX therapy includes discontinuation of the offending drug and the use of corticosteroids. Platelet transfusion and intravenous immunoglobulin may be required in some patients.. Thrombocytopenia associated with TMP/SMX therapy can be serious or life threatening because it may result in significant bleeding complications. This hematologic adverse effect of TMP/SMX may occur even with the usual recommended dosage and duration of therapy. Careful monitoring of complete blood cell count, including platelet count, before and during TMP/SMX therapy is suggested.

Topics: Anti-Infective Agents; Blood Cell Count; Chronic Disease; Female; Humans; Middle Aged; Platelet Count; Sinusitis; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

The diagnosis of acute sinusitis has been regarded as a serious condition that requires the use of antibiotics. However the increasing incidence of resistant organisms means antibiotics need to be used carefully.. To look at the evidence available regarding antibiotic use for sinusitis, and to discuss its application to general practice.. There have been surprisingly few randomised double blind placebo controlled trials for sinusitis, and fewer still have been based in a representative population of primary care patients. This article discusses studies relevant to general practice. Several practical clinical symptoms and signs have been shown to increase the likelihood of a patient having acute bacterial sinusitis, and therefore benefit from antibiotics. When antibiotics are used, comparative data suggest that amoxycillin should be used first line. The issue of patient experience, expectations and satisfaction is also raised.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Endoscopy; Humans; Patient Selection; Penicillins; Randomized Controlled Trials as Topic; Sinusitis; Time Factors; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Anti-Infective Agents; Female; Humans; Immunoglobulins, Intravenous; Sinusitis; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

To determine whether treatment with an antibiotic (trimethoprim-sulfamethoxazole) reduced the inflammatory response in a murine form of Streptococcus pneumoniae-induced rhinosinusitis.. We randomized 18 C57BL/6 mice to either treatment with intraperitoneal trimethoprim-sulfamethoxazole (Bactrim, 30 mg/kg) or no treatment (control). After 2 days, we inoculated all C57BL/6 mice intranasally with a Bactrim-susceptible strain of Streptococcus pneumoniae, ATCC 49619, suspended in Trypticase soy broth. At day 5 after bacterial inoculation, we sacrificed the mice and prepared histopathologic sections of their sinuses after culturing their nasal cavities by lavage.. Animal care facility at a tertiary, academic institution.. The histopathologic sections of the sinuses were examined in a blind manner for the percent of sinus cavity area occupied by neutrophil clusters, and for the number of neutrophils per square millimeter of sinus mucosa.. The Bactrim group had a significantly smaller sinus area occupied by neutrophil clusters (1.58% +/- 1.13 vs 4.38% +/- 3.41; P < 0.05), significantly fewer neutrophils infiltrating the mucosa (58.81 +/- 29.63/mm2 vs 105.85 +/- 48.49/mm2; P < 0.05), and significantly less growth of Streptococcus pneumoniae colonies in the intranasal cultures (8 few and 1 moderate vs 3 few, 3 moderate, and 1 many; P = 0.05) compared to the control group.. In our murine model of acute rhinosinusitis, Bactrim decreased the number of neutrophil clusters in the sinus cavities, the number of neutrophils infiltrating the sinus mucosa, and the growth of Streptococcus pneumoniae. We propose that our murine model can be used for the study of the pathophysiology and treatment of acute rhinosinusitis.

Topics: Animals; Disease Models, Animal; Inflammation; Leukocyte Count; Mice; Neutrophils; Rhinitis; Sinusitis; Streptococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; AIDS-Related Opportunistic Infections; Chemical and Drug Induced Liver Injury; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Liver Function Tests; Pneumonia, Pneumocystis; Sinusitis; Transaminases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Cystitis; Female; Humans; Male; Meningitis, Aseptic; Middle Aged; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination

The antibiotic susceptibility of pneumococci isolated from clinical specimens from 1991 through 1994 was investigated. Of 305 strains tested by the agar dilution method, 16 (5.2%) were resistant to penicillin (MICs > or = 0.12 mg/l). Of the resistant strains, 0.3% showed high-level resistance (MIC > or = 2 mg/l). The rate of resistance to erythromycin (MIC > or = 4 mg/l) was 2.3%, to tetracycline (MIC > or = 8 mg/l) 8.5%, to chloramphenicol (MIC > or = 8 mg/l) 1.0%, and to trimethoprim sulfamethoxazole (MIC > or = 3.2/64 mg/l) 3.3%. Penicillin-resistant strains showed significantly higher resistance to the other antibiotics tested. Resistance to penicillin was higher in isolates from the respiratory tract than in those from blood and cerebrospinal fluid (6.2% vs. 2.4%, respectively). There was no increase in penicillin resistance from 1991 through 1994 (5.3% vs. 4.9%, respectively).

Topics: Anti-Bacterial Agents; Austria; Bronchitis; Chloramphenicol Resistance; Erythromycin; Humans; Microbial Sensitivity Tests; Nasopharynx; Penicillin Resistance; Sinusitis; Sputum; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

The following report illustrates a case of trimethoprim/sulfamethoxazole-induced hypoprothrombinemia in a patient receiving ongoing warfarin therapy for atrial fibrillation and aortic valve replacement. He was treated with trimethoprim/sulfamethoxazole (TMP/SMX) for sinusitis. During this time, the patient's prothrombin time international normalized ratio (INR) increased 3.5 times higher than the baseline value. The INR values decreased when the antibiotic was discontinued. If a patient is on warfarin and TMP/SMX is added, INR values should be monitored closely.

Topics: Aged; Aortic Valve; Atrial Fibrillation; Drug Interactions; Heart Valve Prosthesis; Humans; Hypoprothrombinemias; Male; Prothrombin Time; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin

A child with dihydropteridine reductase (DHPR) deficiency developed signs of dopamine insufficiency after being given trimethoprim-sulfamethoxazole (TMP-SMX). She recovered function after the antibiotic was stopped, which suggests that it adversely influenced dopamine metabolism in the CNS. The authors speculate that TMP, a dihydrofolate reductase inhibitor, was the major cause of the patient's deterioration, and suggest that it and other dihydrofolate inhibitors, notably methotrexate, are contra-indicated for patients with DHPR deficiency.

Topics: Child, Preschool; Dopamine; Epinephrine; Female; Humans; NADH, NADPH Oxidoreductases; Norepinephrine; Phenylalanine; Phenylketonurias; Sinusitis; Tremor; Trimethoprim, Sulfamethoxazole Drug Combination

Branhamella catarrhalis--a Gram-negative diplococcus--differs biochemically from other Neisseriaceae and possesses a specific protein with antigenic properties. Although scattered cases of meningitis and endocarditis have been reported since 1907, B. catarrhalis has been considered a non-pathogenic, pharyngeal commensal. However, relatively recent reports have shown B. catarrhalis to play a significant role in the etiology of otitis media and bronchopulmonary infections. Some reports also indicate a pathogenic role in sinusitis and longstanding cough in children, and in acute laryngitis in adults. B. catarrhalis is susceptible to co-trimoxazole, erythromycin, cephalosporins and tetracyclines. Most strains are also susceptible to penicillin, but the frequency of beta-lactamase producing B. catarrhalis has increased from 4% to 25% during the last six years (Sweden). First choice antibiotics in infections with penicillin-resistant strains would be erythromycin and co-trimoxazole.

Topics: Anti-Bacterial Agents; Bacterial Infections; Drug Combinations; Drug Resistance, Microbial; Erythromycin; Humans; Laryngitis; Microbial Sensitivity Tests; Neisseria; Otitis Media with Effusion; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination