trimethoprim--sulfamethoxazole-drug-combination and Spondylitis

Brucellosis, a zoonotic infection caused by the genus Brucellae, is an ancient condition linked to the consumption of milk and milk products. The disease has global importance due to its impact. Therapeutic options for brucellosis rely mostly on uncontrolled, nonrandomized, non-blinded studies. The choice and duration of therapy are related to patient characteristics and the presence of a focal disease. The usual therapy of acute brucellosis is a combination of doxycycline plus rifampicin for 6 weeks. An aminoglycoside could be substituted for rifampin for the initial week of combination therapy. Other alternatives include a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a fluoroquinolone plus rifampicin. The presence of spondylitis or endocarditis usually indicates that the required treatment will be of a longer duration or a combination of therapy. The article has the discussion of some recent patents related to antibiotic susceptibility and Brucellosis.

Topics: Anti-Bacterial Agents; Bone Diseases, Infectious; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Patents as Topic; Rifampin; Spondylitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A case of cervical spine infection due to Streptococcus anginosus is reported. Streptococcus milleri is encountered in the mouth, gastro-intestinal tract, vagina and nasopharynx. It is an uncommon pathogen responsible of suppurative infections such as brain liver or spleen abscesses, intra-abdominal or soft tissue abscesses and pleural empyema. In rare cases it can cause spondylodiscitis and osteomyelitis. Based on the review of eight cases of spondylodiscitis or osteomyelitis, diagnosis and treatment are discussed.

Topics: Adult; Ampicillin; Cervical Vertebrae; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Neck Pain; Spondylitis; Streptococcal Infections; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

1) To identify patients of brucella spondylitis and sacroiliitis amongst patients of 'infective spondylitis' and 'sacroiliitis', 2) To study clinical and radiographic features and outcome of brucella spondylitis.. We reviewed 21 patients of infective spondylitis and 12 of sacroiliitis attending our hospital between March and September 2000 and followed them to identify patients of brucella spondylitis and brucella sacroiliitis, using serological tests.. 1) Twenty six patients (17 spondylitis and nine sacroiliitis) were detected to have brucella infection to be the cause of their illness. 2) Brucella spondylitis is commonly mistaken for tuberculous spondylitis in our country. Thus leading to a delay in the diagnosis as well as occurrence of angular deformity and neurological deficit, which are reportedly uncommon in this condition. 3) Consumption (or handling) of unpasteurized milk (tabela milk) and occasional animal contact were found to be the source of infection in the general population. 4) Predominantly lumbar spine involvement, end-plate erosion of L4, L3, L5, decreased intervertebral disc space, repair with'formation of an osteophyte, simultaneous involvement of several sites and association of spondylitis with sacroiliitis were important radiographic features.. Brucellosis exists in the general population, high clinical suspicion especially when there is history of animal contact or consumption of unpasteurized milk, familiarity with clinical and radiological features of brucella spondylitis and detection of antibodies to brucella by ELISA will help us detect and treat these patients in time.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Brucella abortus; Brucella melitensis; Brucellosis; Doxycycline; Enzyme-Linked Immunosorbent Assay; Female; Humans; India; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Sacroiliac Joint; Spondylitis; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the efficacy and safety of cotrimoxazol plus rifampicin in staphylococcal osteoarticular infection.. Open, non-comparative study of adult hospitalized patients with documented staphylococcal bone infection.. From Feb 1989 to Dec 1993 28 episodes of staphylococcal bone infection were treated in 14 men and 13 women; the mean age was 48 +/- 21 years (range, 11-84). They received cotrimoxazol (7 mg/kg/day of trimethoprim) plus rifampicin (600-1200 mg/day), both orally, every 8 to 12 h with a mean duration of treatment of 34.2 +/- 8.2 days (range, 21 to 55 days). This antibiotic regimen was initiated at the same time that appropriate surgery for each specific condition was undertaken. Diagnoses were postsurgical osteomyelitis (10 cases), infected total hip prostheses (4 cases, one with 2 episodes), osteomyelitis secondary to external pin fixation (5 cases), soft tissue infections linked to orthopedic implants (3 cases), two cases of metatarsal osteomyelitis (one diabetic foot and one patient with polineuropathy), and one case each of chronic osteomyelitis of femur, hematogenous lumbar spondylitis and posttraumatic osteomyelitis. Four patients had bacteremia. The duration of the infection, prior to surgery was less than one month in 12 episodes, 1 month to 2 years in 14, and in 2 cases, of 10 and 13 years, respectively. In 23 episodes the causal agent was Staphylococcus aureus and in 5 cases it was coagulase-negative staphylococci. Patients had received previous parenteral therapy with other antimicrobials during 2-40 days (X: 18.6 +/- 10.2 days). All patients but one had resolution of the infection and are currently asymptomatic 6 months to 5 years posttreatment in the 21 evaluable cases (X: 38 +/- 13.1 months). Five patients had adverse effects secondary to the antibiotic combination and in three these were severe enough to discontinue the antimicrobials. In no case of the 11 patients with post-treatment control cultures were staphylococci recovered from the wound.. The combination of cotrimoxazole plus rifampicin, both given orally, was highly effective in this selected group of patients. This combination should be considered as a useful alternative therapy of staphylococcal bone infection and deserves further study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Drug Therapy, Combination; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Retrospective Studies; Rifampin; Spondylitis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report two patients with chronic granulomatous disease (CGD) and life-threatening infections: a 10 10/12-year-old boy had Aspergillus fumigatus spondylitis with destruction of the 11th vertebral body and paravertebral abscess formation, and an 8 5/12-year-old boy had multiple Staphylococcus aureus hepatic abscesses with subphrenic abscess formation. Both patients failed to respond to intense antimicrobial therapy but showed a remarkable recovery following surgical drainage combined with granulocyte transfusions. These results suggest that antimicrobial therapy and surgical drainage followed by granulocyte transfusions may be the ideal mode of treatment for severe infections in patients with CGD.

Topics: Amphotericin B; Blood Transfusion; Child; Drug Combinations; Flucytosine; Granulocytes; Granulomatous Disease, Chronic; Humans; Liver Abscess; Male; Spondylitis; Staphylococcal Infections; Subphrenic Abscess; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Salmonellosis rarely causes osteomyelitis in previously healthy children. A 15-year-old girl was found to have vertebral osteomyelitis due to Salmonella cerro, the first-reported case to the best of our knowledge. Standard treatment with ampicillin and trimethoprim-sulfamethoxazole failed to cure the infection. She recovered after a course of moxalactam therapy and surgery.

Topics: Adolescent; Ampicillin; Cephamycins; Drug Combinations; Female; Humans; Lumbar Vertebrae; Moxalactam; Osteomyelitis; Salmonella Infections; Spondylitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination