zithromax and Conjunctivitis--Bacterial

With the continued high prevalence of chlamydia worldwide and high risk of transfer from mothers to their infant during delivery, a need for safe and effective therapies for infants who acquire a chlamydial infection remains. We conducted a systematic review and meta-analysis of antibiotic treatments, including oral erythromycin, azithromycin, and trimethoprim, for neonatal chlamydial conjunctivitis.. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception to July 14, 2017. We included randomized and nonrandomized studies that evaluated the effects of erythromycin, azithromycin, or trimethoprim in neonates with chlamydial conjunctivitis. A meta-analysis using a random-effects generic inverse-variance method was performed, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.. We found 12 studies (n = 292 neonates) and were able to meta-analyze 7 studies that used erythromycin at a dose of 50 mg/kg body weight per day for 14 days. The clinical and microbiological cure were 96% (95% confidence interval [CI], 94%-100%) and 97% (95% CI, 95%-99%), respectively, and adverse gastrointestinal effects occurred in 14% (95% CI, 1%-28%) of the neonates. The microbiological cure in the study that assessed azithromycin at 20 mg/kg per day were 60% (95% CI, 27%-93%) when it was given in a single dose and 86% (95% CI, 61%-100%) when given in a 3-day course. Two studies reported compliance with treatments, and 1 study reported no pyloric stenosis events. Because of the risk of bias and the few neonates included across the studies, the certainty of evidence is low to very low. No studies assessed trimethoprim.. Although evidence suggests that erythromycin at 50 mg/kg per day for 14 days results in higher numbers of cure than does azithromycin, compliance and risk of pyloric stenosis related to their use for other infections in neonates will factor into treatment recommendations. More data are needed to compare these treatments directly.

Topics: Anti-Bacterial Agents; Azithromycin; Bias; Chlamydia Infections; Chlamydia trachomatis; Conjunctivitis, Bacterial; Drug Administration Schedule; Erythromycin; Female; Gastrointestinal Diseases; Humans; Infant, Newborn; Male; Pyloric Stenosis; Risk Factors; Trimethoprim

Vertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis.. In a double-blind, randomized trial, we assessed the effect of administering a single dose of oral azithromycin to women in labour on bacterial colonization of the neonate. A reduction in purulent neonatal conjunctivitis was a secondary objective of the trial. Ocular samples were collected from the lower fornix of infants presenting with clinical signs of purulent conjunctivitis during the first eight weeks of life. Incidence of purulent conjunctivitis was compared between trial arms. Bacterial infection was assessed using PCR and incidence of purulent conjunctivitis due to bacteria was also compared between arms.. Forty of 843 infants (4.7%) presented clinical signs of purulent conjunctivitis. No significant difference in incidence of purulent conjunctivitis was seen between azithromycin and placebo arms [4.3% (18/419) versus 5.2% (22/424), OR = 0.82, 95% CI (0.44,1.54), p = 0.628]. S. aureus was the most commonly identified pathogen, detected in 38% of cases. Incidence of purulent-conjunctivitis due to bacterial infection was lower in the azithromycin arm [1.2% (5/419) versus 3.8% (16/424), OR = 0.31, 95% CI (0.12-0.82), p = 0.025)]. The incidence of gram-positive bacteria was also lower in the azithromycin arm [1.0% (4/419) versus 3.3% (14/424), OR = 0.28, 95%CI (0.10-0.82), p = 0.029].. Oral azithromycin given to women during labour may have the potential to reduce the incidence of bacterial neonatal conjunctivitis.. ClinicalTrials.gov, identifier NCT01800942 , registration date 26 Feb 2013.

Topics: Administration, Oral; Adult; Azithromycin; Bacteria; Conjunctivitis, Bacterial; DNA, Bacterial; Double-Blind Method; Female; Humans; Incidence; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Odds Ratio; Parturition; Placebo Effect; Risk Factors; Staphylococcus aureus; Treatment Outcome; Young Adult

To determine the efficacy and safety of azithromycin 1.5% eye drops in a paediatric population with purulent bacterial conjunctivitis.. This was a multicentre, international, randomised, investigator-masked study in 286 children with purulent discharge and bulbar conjunctival injection. Patients received either azithromycin 1.5% eye drops (twice daily for 3 days) or tobramycin 0.3% eye drops (every 2 h for 2 days, then four times daily for 5 days). Clinical signs were evaluated on day (D) 0, 3 and 7, and cultures on D0 and D7. The primary variable was the clinical cure (absence of bulbar conjunctival injection and discharge) on D3 in the worse eye for patients with positive cultures on D0.. 286 patients (mean age 3.2 years; range 1 day-17 years) were included; 203 had positive cultures on D0. Azithromycin was superior to tobramycin in clinical cure rate on D3 (47.1% vs 28.7%, p=0.013) and was non-inferior to tobramycin on D7 (89.2% vs 78.2%, respectively). Azithromycin treatment eradicated causative pathogens, including resistant species, with a similar resolution rate to tobramycin (89.8% vs 87.2%, respectively). These results were confirmed in a subgroup of patients younger than 24 months old.. Azithromycin 1.5% eye drops provided a more rapid clinical cure than tobramycin 0.3% eye drops in the treatment of purulent bacterial conjunctivitis in children, with a more convenient twice-a-day dosing regimen.

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Azithromycin; Bacteria; Child; Child, Preschool; Conjunctivitis, Bacterial; Eye Infections, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Ophthalmic Solutions; Tobramycin; Treatment Outcome

To evaluate the clinical efficacy and safety of tobramycin/dexamethasone (TobraDex ST ; 'ST') ophthalmic suspension 0.3%/0.05% compared to azithromycin (Azasite) ophthalmic solution (1%) in the treatment of moderate to severe blepharitis/blepharoconjunctivitis.. The study was a multicenter, randomized, investigator-masked, and active-controlled, 15-day study. Enrolled in the study were 122 adult subjects (at least 18 years of age) diagnosed with moderate to severe blepharitis/blepharoconjunctivitis, defined by a minimum score of at least '1' for one of the lid signs, one of the conjunctival signs, and one of the symptoms in at least one eye and a minimum global score (total signs and symptoms score) of '5' in the same eye. One group of 61 subjects received ST with instructions to dose 1  drop four times daily (QID) for 14 days. The other group of 61 subjects received azithromycin and dosed with 1 drop twice daily (BID) for 2 days followed by once daily (QD) dosing for 12 days. Visits were conducted at Day 1 (baseline), Day 8 and Day 15. The a priori primary outcome parameter of the study was the seven-item global score defined as the total score of lid margin redness, bulbar conjunctival redness, palpebral conjunctival redness, ocular discharge (0-3 scale), and lid swelling, itchy eyelids, and gritty eyes (0-4 scale). The study utilized standardized, validated photograph control scales developed by Ora, Inc. (Andover, MA).. The study was registered at ClinicalTrials.gov under the registry number NCT01102244.. A statistically significant lower mean global score (p = 0.0002) was observed in subjects treated with ST compared to subjects treated with azithromycin at Day 8. No serious adverse events were reported during the course of the study in either group.. ST provides a fast and effective treatment of acute blepharitis compared to azithromycin. Initial therapy with the combination of tobramycin/dexamethasone provides faster inflammation relief than azithromycin for moderate to severe blepharitis/blepharoconjunctivitis.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Blepharitis; Conjunctivitis, Bacterial; Dexamethasone; Drug Combinations; Female; Humans; Instillation, Drug; Male; Middle Aged; Ophthalmic Solutions; Osmolar Concentration; Tobramycin; Treatment Outcome; Validation Studies as Topic

Purulent bacterial conjunctivitis affects all ages with high frequency in newborns and children. In a subset of 150 children included in a large study having enrolled 1043 patients, our aim was to analyze in children, the efficacy and safety of azithromycin 1.5% eye-drops in the treatment of this disease.. This multicenter, randomized, investigator-masked, parallel-group study, included 150 children and adolescents to study safety and compare azithromycin 1.5% eye drops twice daily for 3 days and tobramycin 0.3% 1 drop every 2 hours for 2 days then 4 times daily for 5 days. Out of 150 patients included, 58 had positive cultures and were studied for efficacy. Signs and symptoms were evaluated and cultures obtained at baseline, Days 3 and 9. Primary efficacy variable was the clinical cure (score 0 for bulbar conjunctival injection and purulent discharge) at the test of cure visit (day 9).. Both treatments were effective with a clinical and microbiologic cure of more than 80% of children on day 9. Azithromycin therapy provided a greater bacteriologic cure on day 3 than did tobramycin (P < 0.001) and eradicated bacteria that were defined as resistant, using classical antibiogram. No adverse effects were noted on the ocular surface.. Azithromycin 1.5% eye drops leads to a rapid clinical and microbiological cure.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bacteria; Child; Child, Preschool; Conjunctivitis, Bacterial; Female; Humans; Infant, Newborn; Male; Ophthalmic Solutions; Tobramycin; Treatment Outcome; Young Adult

Bacterial conjunctivitis is characterized by hyperemia and discharge of one or both eyes. These clinical signs appear quickly and are contagious. This study compares the clinical efficacy (signs and symptoms) and safety of azithromycin 1.5% eye drops with tobramycin 0.3%.. This was a multicenter, randomized, investigator-masked study including 1,043 patients with purulent bacterial conjunctivitis. Patients received either azithromycin twice daily for 3 days or tobramycin, 1 drop every 2 hours for 2 days, then four times daily for 5 days. The primary variable was clinical cure at the test-of-cure (TOC) visit (D9) on the worst eye. The cure was defined as bulbar conjunctival injection and discharge scores of 0. Clinical signs were evaluated at D0, D3, and D9.. In the azithromycin group 87.8% of patients and in the tobramycin group 89.4% were clinically cured at D9. Clinical cure with azithromycin was not inferior to tobramycin at D9: discharge was absent in 96.3% of patients treated with azithromycin and 95.1% with tobramycin. Azithromycin was well tolerated.. Azithromycin 1.5% for 3 days (six drops) was as effective as tobramycin for 7 days (36 drops). Furthermore, patients on azithromycin presented earlier clinical cure on Day 3 than patients on tobramycin. Azyter, with its convenient dosing (bid for 3 days), is a step forward in the management of purulent bacterial conjunctivitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Conjunctiva; Conjunctivitis, Bacterial; Edema; Erythema; Eyelid Diseases; Follow-Up Studies; Humans; Hyperemia; Infant; Infant, Newborn; Middle Aged; Ophthalmic Solutions; Safety; Single-Blind Method; Suppuration; Tobramycin; Treatment Outcome; Young Adult

Azithromycin is a macrolide class antibiotic, recently adapted for topical use in ophthalmology. It is effective against the most frequent pathogens found in bacterial conjunctivitis, Gram positive and Gram negative bacteria. Azithromycin has the specificity to have sustained high tissue levels: after repeated instillation, it has been shown to reach sustained concentrations above the MICs of susceptible bacteria for 4 days in tears and for 7 days in conjunctiva.. To investigate the effectiveness and tolerance of treatment with Azithromycin 1.5% eye drops in bacterial conjunctivitis.. The prospective study included 40 patients (69 eyes) with purulent bacterial conjunctivitis; aged 21-70 years; average: 38.05 Patients were treated with 1.5% azithromycin eye drops topically twice-daily for 3 days. Conjunctival swabbings were taken at the 1st and the 7th +/- 1 day of the treatment. Effectiveness and tolerance of eye drops were assessed in 7th +/- 1 day from the beginning of the treatment.. Bacteriological cultures were positive before treatment in 34 eyes (49.28%), negative--35 eyes (50.72%). In 69 eyes with bacterial conjunctivitis the following microorganisms were identyfied (34 eyes): Streptococcus pneumoniae 23.53% (8 eyes), Staphyllococcus aureus 23.53% (8 eyes), Staphyllococcus epidermidis 20.59% (7 eyes), Haemophilus influenzae 17.65% (6 eyes), Morganella Morgani 2.94% (1 eye), Proteus mirabilis 2.94% (1 eye), Enterococcus species 2.94% (1 eye), Streptococcus viridians 2.94% (1 eye), Moraxella (Branhamella) catarrhalis 2.94% (1 eye). Positive bacteriological culture at the 7th day of treatment--2 eyes (1 eye--Staphyllococcus epidermidis MSCNS, 1 eye--Morganella Morgani). Clinical recovery or significant improvement were observed in 68 of 69 evaluated eyes.. Three-day topical therapy with azithromycin 1.5% eye drops is an effective and well tolerated therapy for purulent bacterial conjunctivitis.

Topics: Adult; Aged; Azithromycin; Conjunctivitis, Bacterial; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Prospective Studies; Treatment Outcome

To analyze the effect of azithromycin 1% ophthalmic solution in DuraSite (InSite Vision, Inc, Alameda, California, USA) on bacterial conjunctivitis.. Prospective, randomized, vehicle-controlled, parallel-group, double-masked multicenter clinical study.. Eligible male or female participants with a clinical diagnosis of acute bacterial conjunctivitis were randomized to either 1% azithromycin in DuraSite or vehicle for five days. Infected eyes were dosed twice daily on days 1 and 2 and once daily on days 3 through 5. Conjunctival cultures were obtained at baseline, visit 2 (day 3 or 4), and visit 3 (day 6 or 7). The primary end point was clinical resolution of signs and symptoms (rating of zero on ocular discharge, bulbar and palpebral injection) at visit 3. Efficacy measures were clinical resolution and bacterial eradication as evaluated in the per-protocol population. Safety was assessed by adverse events, slit-lamp findings, and ophthalmoscopy.. Two hundred and seventy-nine participants (n = 130, 1% azithromycin in DuraSite; n = 149, vehicle), age one to 96 years, were evaluated for efficacy. Clinical resolution with azithromycin ophthalmic solution was statistically significant compared with that of vehicle (P = .030) at visit 3. Bacterial eradication rates with azithromycin ophthalmic solution reached 88.5% at visit 3 (P < .001) and included some pathogens resistant to azithromycin in vitro. Overall, adverse event rates were similar in both treatment groups.. Azithromycin 1% ophthalmic solution in DuraSite showed statistically significant differences in clinical resolution and bacterial eradication rates when compared with vehicle. Because it was well tolerated in this population, it may be a viable treatment option for children and adults with bacterial conjunctivitis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Conjunctivitis, Bacterial; Double-Blind Method; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Ophthalmic Solutions; Pharmaceutical Vehicles; Prospective Studies

To compare the efficacy and safety of Azyter, azithromycin 1.5% eye drops, for 3 days with tobramycin 0.3% for 7 days to treat purulent bacterial conjunctivitis.. This was a multicentre, randomised, investigator-masked study including 1043 children and adults with purulent bacterial conjunctivitis. Patients received either azithromycin 1.5% twice-daily for 3 days or tobramycin 0.3%, 1 drop every two hours for 2 days, then four times daily for 5 days. Clinical signs were evaluated and cultures obtained at D0, D3 and D9 (where D refers to "day"). Primary variable was the clinical cure at the Test-of-Cure (TOC)-visit (D9+/-1), for patients with D0-positive cultures. The cure was defined as: bulbar conjunctival injection and discharge scores of 0.. Among 471 patients with D0-positivity in the per protocol set, 87.8% of the azithromycin 1.5% group and 89.4% of the tobramycin group were clinically cured at the TOC-visit. Azithromycin was non-inferior to tobramycin for clinical and bacteriological cure. Clinical cure was significantly higher with azithromycin 1.5% at D3. The safety profile of azithromycin was satisfactory with a good patient and investigator's acceptability.. Azithromycin 1.5% for 3 days was as effective and as safe as tobramycin for 7 days. Furthermore, more azithromycin than tobramycin patients presented an early clinical cure at Day 3. Due to its twice daily dosing regimen for 3 days, azithromycin represents a step forward in the management of purulent bacterial conjunctivitis, especially in children.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Conjunctivitis, Bacterial; Drug Administration Schedule; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Ophthalmic Solutions; Single-Blind Method; Tobramycin; Treatment Outcome

To compare the safety and tolerability of 1.0% azithromycin in a polymeric mucoadhesive delivery system with 0.3% tobramycin ophthalmic solution for the treatment of bacterial conjunctivitis.. This study was a prospective, randomized, active-controlled, double-masked, phase 3 trial conducted from August 6, 2004, to October 6, 2005, at 47 sites. Subjects with a clinical diagnosis of bacterial conjunctivitis were randomly assigned to receive either 1% azithromycin in DuraSite (AzaSite; InSite Vision, Alameda, CA) (n = 365) or 0.3% tobramycin (n = 378). Both groups received masked medication four times daily for 5 days, but participants received an active dose of 1% azithromycin in DuraSite only twice a day on days 1 and 2 and daily on days 3 to 5. Conjunctival cultures were taken, and ocular signs and symptoms were evaluated at baseline and at two follow-up visits.. A total of 743 patients were randomized, and 710 (96%) completed the trial. Both study medications were well tolerated. The most frequently observed ocular adverse events in the azithromycin group were eye irritation (1.9%), conjunctival hyperemia (1.1%), and worsening bacterial conjunctivitis (1.1%). These rates compared favorably with those obtained with tobramycin. Rates of microbial eradication (an efficacy parameter) and bacterial infection recurrence (a safety parameter) were the same in both groups.. This is the first report of the safety and tolerability of a commercially manufactured preparation of azithromycin for ophthalmic use. Azithromycin 1% in DuraSite is safe and can be administered in a regimen of less frequent doses than can tobramycin, while producing an equivalent clinical outcome. The formulation is well tolerated in patients over the age of 1 year for the eradication of bacteria commonly associated with conjunctivitis. (ClinicalTrials.gov number, NCT00105469.).

Topics: Adhesives; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Conjunctivitis, Bacterial; Female; Humans; Infant; Male; Middle Aged; Ophthalmic Solutions; Polymers; Prospective Studies; Tobramycin; Treatment Outcome; Visual Acuity

To examine in vitro resistance to azithromycin and moxifloxacin in bacterial conjunctivitis isolates.. MIC90s (Minimum Inhibitory Concentration) and resistance rates to azithromycin and moxifloxacin were determined based upon microtiter broth dilution and/or antimicrobial gradient test strips in a multicenter phase III study and confirmed externally.. The most common isolates collected from bacterial conjunctivitis patients in the phase III study were Haemophilus influenzae (40.6%), followed by Staphylococcus epidermidis (19.3%), Propionibacterium acnes (17.3%), Streptococcus pneumoniae (16.8%), and Staphylococcus aureus (0.06%). MIC90s for all of these organisms were well below established resistance breakpoints for moxifloxacin, indicating no bacterial resistance. On the other hand, the MIC90 for H. influenzae was 3-fold higher than the resistance breakpoint for azithromycin, > or = 128-fold higher for S. epidermidis, 16-fold higher for S. pneumoniae and > or = 128-fold higher for S. aureus, indicating moderate to very high bacterial resistance to azithromycin.. Resistance to azithromycin is more common than resistance to moxifloxacin in clinical isolates causing bacterial conjunctivitis.

Topics: Anti-Bacterial Agents; Aza Compounds; Azithromycin; Conjunctivitis, Bacterial; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Moxifloxacin; Quinolines

Major outer membrane protein sequences, determined from Chlamydia-positive eye swab samples collected in 2 Egyptian villages, were used to analyze the epidemiology of trachoma in an endemic setting. Samples were collected during the 1999 Azithromycin in Control of Trachoma trial, in which residents of villages were mass treated with either oral azithromycin or topical tetracycline and were followed up for nearly 2 years. Three genovar families (A, Ba, and C) and 12 genovars were detected, with 2 genovars (A1 and Ba1) comprising almost 75% of the samples. The presence of >1 genovar within households was common, with > or =24% of households having >1 genovar. Evidence consistent with reinfection and persistence as mechanisms of communitywide continued presence of trachoma was provided by data for individuals infected with rare genovars.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Outer Membrane Proteins; Chlamydia Infections; Chlamydia trachomatis; Conjunctivitis, Bacterial; DNA, Bacterial; Humans; Molecular Epidemiology; Polymerase Chain Reaction; Rural Population; Sequence Analysis, DNA; Tetracycline

In the present study, we aimed to formulate, optimize, and characterize azithromycin chitosan coated niosomes (AZM-CTS-NSM) as a novel colloidal system that increases precorneal residence period, eye permeation, and bioavailability. AZM-NSM was formulated via a modified thin-film hydration strategy and then coated with CTS. We assessed the influence of the cholesterol: surfactant molar ratio, CTS concentration, and surfactant type on particle diameter, entrapment, zeta potential, and NSM adhesion force to the corneal mucosal membrane and employed a central composite design (CCD). The resulting optimized AZM-CTS-NSM has a mean diameter of 376 nm, entrapment of 74.2%, surface charge of 32.1 mV, and mucoadhesion force of 3114 dyne/cm

Topics: Animals; Azithromycin; Chitosan; Conjunctivitis, Bacterial; Cornea; Drug Delivery Systems; Liposomes; Particle Size; Rabbits

Trachoma is a contagious infection of the eye. World Health Organization recommended three rounds of mass drug administration in districts where the prevalence of trachomatous follicular (TF) is ≥10% in children aged 1-9 years. Mass drug distribution was given to residents for three consecutive years with more than 90% coverage. However, the prevalence and associated factors of active trachoma in the study community after the intervention was not yet determined. Thus, this deals with the prevalence and associated factors of active trachoma among children aged 1-9 years.. We conducted a Community based cross-sectional study among 502 children aged 1-9 in March 2018 in Deguatemben. A multi-stage sampling technique was applied. Selected children were examined for trachoma using 2.5x binocular loupe and graded based on the WHO simplified grading system. Mothers were interviewed for factors associated with trachoma using a structured questionnaire. Data was entered on Epi-Info and exported to SPSS for analysis. Both descriptive and inferential analyses were done with 95% confidence intervals (CIs) at a p-value < 0.05 for the final model.. The prevalence of active trachoma was found 21.5% (95% CI: 17.8-25.1%). Being 1 to 4 years old [AOR (95% CI) = 6.81(2.00-23.11)], not washing face [AOR (95% CI) =9.31(1.13-77.66)], not using soap [AOR (95% CI) =5.84(1.87-18.21)], unclean face [AOR(95% CI) = 18.22(4.93-69.32)] and mother's knowledge [AOR (95% CI) =0.06(0.02-0.19)] were found as independent predictors.. The prevalence declined from the baseline, but it is still a public health problem in the district. Personal-related factors were found to be associated with the disease. Health education of "Facial cleanness" and related factors is recommended to increase knowledge of the mothers on their children's care in addition to the provision of antibiotics.

Topics: Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Conjunctivitis, Bacterial; Cross-Sectional Studies; Ethiopia; Eye Infections, Bacterial; Female; Humans; Infant; Male; Prevalence; Risk Factors; Rural Population; Surveys and Questionnaires; Trachoma

A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Conjunctivitis, Bacterial; Facial Nerve Diseases; Humans; Lymphadenitis; Male; Ocular Motility Disorders; Tomography, X-Ray Computed

The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study evaluates in vitro antibiotic resistance among Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Here we report resistance rates and trends among conjunctival-sourced ocular isolates collected across the US from 2009 through 2016. A total of 1198 conjunctival isolates (483 S. aureus, 305 CoNS, 208 H. influenzae, 118 S. pneumoniae, and 84 P. aeruginosa) were collected from patients with presumed bacterial conjunctivitis from 57 sites across 40 states. A large proportion of staphylococci demonstrated resistance to oxacillin and azithromycin, while resistance was low against the majority of antibiotics tested for S. pneumoniae, P. aeruginosa, and H. influenzae. Multidrug resistance (≥3 antibiotic classes) was found in 30.2% of S. aureus and 39.0% of CoNS isolates, and methicillin resistance more than doubled the rate of multi-drug resistance (methicillin-resistant S. aureus [MRSA], 76.5%; methicillin-resistant CoNS isolates, 72.8%). There was a pattern of increasing mean percent resistance with increasing age by decade of life among S. aureus, MRSA, and CoNS (P≤0.038). Over the eight-year study period, there were small yet significant decreases in resistance rates among S. aureus to azithromycin, ciprofloxacin, tobramycin, trimethoprim, and oxacillin (P≤0.003), and among CoNS and P. aeruginosa (both P<0.05) to ciprofloxacin. These data indicate that antibiotic resistance is high, but did not increase, among conjunctival-sourced isolates collected in the US from 2009 through 2016. For certain antibiotic/pathogen combinations, there was a trend of decreased resistance, including a decrease in oxacillin resistance among S. aureus.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Ciprofloxacin; Conjunctiva; Conjunctivitis, Bacterial; Drug Resistance, Multiple, Bacterial; Epidemiological Monitoring; Female; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Male; Methicillin; Microbial Sensitivity Tests; Middle Aged; Oxacillin; Pseudomonas aeruginosa; Staphylococcus aureus; Streptococcus pneumoniae; Tobramycin; Trimethoprim; United States

Gonococcal conjunctivitis is a rare infection induced by Neisseria gonorrhoeae and it usually manifests as a hyperacute purulent conjunctivitis. Ocular access of the infectious secretion during sexual intercourse is the way of transmission among adults. Inclusion conjunctivitis caused by the serovars D-K of Chlamydia trachomatis also affects the sexually active population. Authors present a case of a 33-year-old homosexual man who was treated for late latent syphilis formerly. Clinical symptoms were yellow purulent discharge for 3 weeks without any urological or upper respiratory tract symptoms. Conjunctival Neisseria gonorrhoeae and Chlamydia trachomatis infection was identified using cultures and polymerase chain reaction; pharyngeal swab culture and polymerase chain reaction showed positive results for both pathogens. The patient was probably under influence of party drugs at the time of sexual abuse when he became infected. After parenteral and oral cephalosporin and azithromycin therapy the patient had complete recovery within three weeks.. A keratoconjunctivitis gonorrhoica ritka, a Neisseria gonorrhoeae által okozott gennyes váladékozással kísért kötőhártya-gyulladás, amelyet felnőtteknél a szembe kerülő fertőző váladék okozhat. A Chlamydia trachomatis D-K szerotípusa által okozott conjunctivitis felnőttkori formáját nemi váladékok szembe kerülésével létrejött, kétoldali mucopurulens váladékozással kísért gyulladás jellemzi. A szerzők egy 33 éves, syphilis latens tarda miatt gondozott férfi beteg esetét ismertetik, akinek a hetek óta fennálló purulens conjunctivitise hátterében a mikrobiológiai vizsgálatok során Chlamydia trachomatis-fertőzéssel kombinált Neisseria gonorrhoeae-infekció igazolódott. A tenyésztéses és PCR-vizsgálatok során a pharynxból is kimutatható volt mindkét kórokozó. A betegnek sem urológiai, sem felső légúti tünetei nem voltak. A fertőződés kábítószer hatása alatt történt szexuális abúzust követően alakult ki. A parenteralis, majd per os cephalosporin- és azithromycinterápia hatására három hét alatt teljes remisszió következett be. Orv. Hetil., 2013, 154, 834–837.

Topics: Acute Disease; Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; Cephalosporins; Chlamydia trachomatis; Coinfection; Conjunctivitis, Bacterial; Conjunctivitis, Inclusion; Homosexuality, Male; Humans; Injections, Intravenous; Male; Neisseria gonorrhoeae; Polymerase Chain Reaction; Sex Offenses; Sexual Behavior; Staphylococcus aureus

We describe the management of a female patient who developed an uncomplicated unilateral purulent conjunctivitis with no other clinical signs. The typical clinical presentation and Gram stain of the discharge suggested gonococcal conjunctivitis, allowing treatment to be initiated. Indeed, a strain of Neisseria gonorrhoeae resistant to penicillin and tetracycline was isolated. In collaboration with the patient's primary care physician, management included lavage of the infected eye, systemic antibiotic treatment with erythromycin and topical antibiotic treatment with azithromycin, followed by local steroid treatment in response to persistent hyperemia, which was discontinued and replaced by azithromycin again because of recurrent discharge. Eleven days after the first consultation, a complete cure was achieved without sequelae, and a final check to rule out a residual gonococcal carrier state is planned. Gonococcal conjunctivitis, a diagnostic and therapeutic emergency, is a potentially blinding sexually transmitted disease with which general practitioners and ophthalmologists are not well aquainted. Although rare in developed countries, its incidence is rising in parallel with the global recrudescence of gonococcal infections. This case of gonococcal conjunctivitis is discussed as a review of the clinical and biological elements necessary for diagnosis and therapeutic management, which must occur as early as possible, taking into account rapidly increasing gonococcal resistance to antimicrobial therapies, so as to interrupt spread of the disease.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Conjunctivitis, Bacterial; Female; Gonorrhea; Humans; Neisseria gonorrhoeae

The pharmacokinetics of a 2% ocular solution of azithromycin in DuraSite was evaluated in rabbits to determine whether the PK/PD parameters support a once-a-day for three-day therapeutic regimen against bacterial conjunctivitis.. Mean levels of azithromycin were determined in tears, bulbar conjunctiva, cornea, and plasma following a single drop of 2% azithromycin. The levels were determined by HPLC-MS.. Concentrations of azithromycin peaked at 30 minutes. At the end of 24 hours, ocular tissue concentrations exceeded the MIC breakpoint for the most common causative pathogens of bacterial conjunctivitis by at least 7-fold.. The PK/PD profile of 2% azithromycin suggests efficacy against common causative bacteria with just one dose per day for three days.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Biological Availability; Chromatography, High Pressure Liquid; Conjunctivitis, Bacterial; Drug Delivery Systems; Male; Microbial Sensitivity Tests; Rabbits; Tandem Mass Spectrometry

Topics: Anti-Bacterial Agents; Azithromycin; Conjunctivitis, Bacterial; Humans; Ophthalmic Solutions; Randomized Controlled Trials as Topic; Treatment Outcome

Antibiotics have traditionally been classified as bactericidal or bacteriostatic. Azithromycin belongs to the parent class of macrolides that are characteristically bacteriostatic. Some evidence suggests that this molecule demonstrates bactericidal kill and has concentration-dependent effects. This study tests the hypothesis that azithromycin demonstrates a bactericidal, concentration-dependent antibiotic effect at concentrations corresponding to and exceeding published tear and conjunctival levels.. The antibacterial activity of different concentrations of azithromycin 1% in DuraSite(R) (AzaSite(R); Inspire Pharmaceuticals Inc, Durham, NC, USA) was evaluated using a kinetics-of-kill model. Recent conjunctivitis isolates of Staphylococcus aureus, Streptococcus pneumoniae or Haemophilus influenzae were exposed to four concentrations of azithromycin (100, 250, 500 and 750 microg/ml). Starting concentrations were similar to the maximum concentrations (Cmax) that have been demonstrated in conjunctiva (83 microg/g) and tears (288 microg/ml) following topical ocular administration. The percentage of surviving bacteria at 30 and 60 minutes following exposure to each concentration were determined.. Azithromycin failed to demonstrate bactericidal activity (i.e. a 3-log reduction in surviving bacteria) against S. aureus, S. pneumoniae or H. influenzae. Furthermore, the rate and extent of antibacterial activity with azithromycin did not change with higher concentrations, even at the highest tested concentration of 750 microg/ml.. Similar to the parent macrolide class, azithromycin demonstrates bacteriostatic activity against common conjunctival pathogens up to the maximum tested concentration of 750 microg/ml (i.e. 2.6-times and 9-times published Cmax tear and conjunctival concentration, respectively). Azithromycin's bacteriostatic effects and prolonged elimination half-life will likely lead to a corresponding increase in the emergence of macrolide-resistant isolates.

Topics: Anti-Bacterial Agents; Azithromycin; Conjunctivitis, Bacterial; Dose-Response Relationship, Drug; Erythromycin; Haemophilus influenzae; Humans; Kinetics; Microbial Sensitivity Tests; Staphylococcus aureus; Streptococcus pneumoniae; Time Factors

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Conjunctivitis, Bacterial; Corneal Injuries; Diagnostic Errors; Female; Humans; Male; Metallurgy; Metals; Occupational Exposure; Urine

To reveal clinical presentations of chlamydial conjunctivitis in contact lens wearers as well as to evaluate the clinical and microbiological efficacy of oral azithromycin in the treatment of this condition.. Twenty contact lens users with chlamydial conjunctivitis were included in this retrospective study. Chlamydial infection was diagnosed by isolation of Chlamydia trachomatis in cell culture of conjunctival scrapings. All patients were treated with a single 1 g oral dose of azithromycin. Follow-up clinical and microbiological examinations were performed 1 month after treatment.. All patients suffered from some ocular symptoms such as itching, burning, tearing, and nonspecific irritation, but none had apparent conjunctival injection or any conjunctival discharge. The majority (90%) had bilateral complaints. Mild follicular reaction, limited to the lateral part of lower fornices, was present in 17 patients; the remaining patients had normal biomicroscopical findings. Four weeks following the single azithromycin dose, C. trachomatiswas eradicated in all patients and 17 (85%) were free of symptoms.. Chlamydial infection should be considered more frequently in differential diagnosis of symptomatic contact lens wearers. Azithromycin is the most promising agent for the treatment of chlamydial conjunctivitis due to its excellent bacteriological efficacy and very convenient single dose administration.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Conjunctiva; Conjunctivitis, Bacterial; Contact Lenses; Female; Humans; Male; Middle Aged; Retrospective Studies