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Профилактика котримоксазолом, начатая на раннем этапе АРТ, приводила к снижению смертности и должна предлагаться ВИЧ-инфицированным пациентам в странах с низким и средним уровнями доходов.
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Sulfamethoxazole inhibited 80% growth of all 117 isolates regardless of their susceptibility to the first-line agents at an MIC(90) of 9.5 mg/L. The concentration required to inhibit 99% growth was 38 mg/L. There were no significant changes in the MIC(50) or MIC(90) of sulfamethoxazole over a 12 year period. All 117 isolates were resistant to trimethoprim at >8 mg/L. The combination of trimethoprim/sulfamethoxazole at a ratio of 1:19 had no additive or synergistic effects.
To examine the use of adjunctive corticosteroids in cases of severe Pneumocystis carinii pneumonia (PCP) in non-HIV-infected adult patients.
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A retrospective review was performed of the charts and radiographs of patients with a granulomatous reaction to P carinii identified from computerised pathology records at Memorial Sloan Kettering Cancer Center, a university affiliated tertiary care hospital.
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In the present report the authors discuss the diagnostic difficulties, therapeutic measures and the clinical course of Nocardia infection which occurred among renal transplant recipients at the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (UH-FRP), from 1968 to 1991. Among 500 individuals submitted to renal transplant, 9 patients developed Nocardiosis at varying times after transplant (two months to over two years). All the patients had pulmonary involvement and their most common symptoms were fever, cough and pleural pain. Dissemination of the process is common and three patients presented cutaneous abscesses, four CNS involvement and one had pericarditis due to Nocardia. The diagnostic is quite difficult since there is no specific clinical picture, concomitant infections are frequent and the microorganism presents slow growth in culture (ranging from four to forty days, in our experience). In this report, three cases were only diagnosed by necropsy. The treatment of choice is a combination of Sulfamethoxazole and Trimethoprim (SMX-TMP). In the present series, overall mortality was 77% (7 cases) and in five of the patients who died the diagnosis was late. All the patients who had CNS involvement died.
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To evaluate the effectiveness of cotrimoxazole in reducing mortality in adults with active TB, irrespective of HIV status, in a high prevalence setting.
A 70-year-old diabetic woman with a nodular goitre developed a swelling in the right neck, increasing over two weeks, as well as fever (38.2 degrees C), increased tendency towards sweating, finger tremors and pain on swallowing. Ultrasound examination of the thyroid raised the suspicion of an abscess, 3.5 x 1.5 cm, at the upper pole of the right thyroid lobe. Material obtained by fine-needle puncture grew Salmonella enteritidis. There have been no symptoms of gastroenteritis at any time. Stool and sputum cultures and nasopharyngeal swabs revealed the sites from which haematogenous spread had come. The abscess regressed (as monitored by ultrasound) within four weeks during intravenous treatment with 1,600 mg/d sulphamethoxazole and 320 mg/d trimethoprim (antibiotics determined by drug sensitivity tests) and after several ultrasound-directed needle punctures. Initially manifest hyperthyroidism (fT4: 3.4 ng/dl; basal TSH: 0.03 microU/l) regressed during the treatment without antithyroid treatment. The patient has been symptom-free for 6 months.
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The analysis showed that the 'hybrid' intervention is the most cost-effective. For 100 skilled employees it would save the company 38,939 US dollars and 73 disability adjusted life-years (DALYs). For unskilled workers 'CTX' is the most cost effective and would save 16,417 US dollars and 60 DALYs. 'Hybrid' has an incremental cost-effectiveness ratio of 45 US dollars per DALY for unskilled workers whereas HAART is far less economical at an incremental cost per DALY of 4118 US dollars. For 'CTX', net savings are preserved across the full range of input values.
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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.
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Co-trimoxazole was found to have a predominantly bacteriostatic effect upon 28 urinary isolates of Enterobacteriaceae in nutrient broth and was never bactericidal in artificially infected urine. The components of co-trimoxazole were tested individually and trimethoprim was found to be at least as effective as co-trimoxazole in nutrient broth and in urine. Trimethoprim alone produced some bactericidal effect in urine but this was antagonized by sulphamethoxazole. Laboratory tests for evaluating these drugs may give a misleading impression of their activity in vivo. Further clinical comparisons should therefore be made between trimethoprim and cotrimoxazole to determine when trimethoprim should be used in preference to the combination.
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No clinical or laboratory parameters were found to be predictive of trimethoprim-sulfamethoxazole-induced cutaneous reactions. Of 38 patients treated with trimethoprim-sulfamethoxazole, 18 (47%) developed cutaneous reactions; these occurred within a median of 11 days (range, 7 to 20 days). Of these 18 patients, 12 (67%) continued to be treated with trimethoprim-sulfamethoxazole through hypersensitivity. Trimethoprim-sulfamethoxazole treatment was continued in 19 (95%) of the 20 patients who did not develop cutaneous reactions (P = .067). The mean duration of trimethoprim-sulfamethoxazole therapy was shorter (18 days) in patients who developed skin reactions than in those who did not (20 days) (P = .016). Noncutaneous side effects accounted for all but one interruption of therapy.