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Medication interactions account for a significant proportion of overanticoagulation in warfarin users. However, little is known about the incidence or degree of interaction with commonly used oral antibiotics.
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The clinical and bacteriological efficacy of norfloxacin and co-trimoxazole was compared in patients with symptomatic upper urinary tract infections (UTI). Norfloxacin 400 mg or cotrimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) were given orally b.i.d. for seven days to 94 Thai patients. Clinical and bacteriological assessments were performed before and at 5, 14 and 21 days after start of treatment. Bacteriological outcome could be evaluated in 69 patients, 35 randomized to norfloxacin and 34 to co-trimoxazole. The bacteriological cure rate assessed four to seven days after treatment was significantly higher in the norfloxacin than in the co-trimoxazole group (94.3% vs. 73.5%; p less than 0.05). Few patients in each group reported mild and transient adverse effects. We conclude that norfloxacin was well tolerated and more effective than co-trimoxazole in the treatment of upper UTI.
The activities of three antibiotics in both Mueller-Hinton broth (MHB) and pooled human urine were compared by using an in vitro pharmacodynamic model. Clinical and reference strains of Escherichia coli were exposed to antibiotics at concentrations achievable in human urine. The rate of bacterial killing (time to a reduction of 3 log10 CFU/ml) and the extent of bacterial killing at 24 h were examined. Between MHB and urine, there were no significant differences in the rate or extent of bacterial killing for both ampicillin and ciprofloxacin. For trimethoprim-sulfamethoxazole there was no significant difference in the extent of bacterial killing in urine compared with that in MHB (P > 0.1); however, there was a significant decrease in the rate of bacterial killing in urine compared with that in MHB (P < 0.001). We conclude that with ampicillin and ciprofloxacin, activity against E. coli in MHB is predictive of the effects in human urine. The activity of trimethoprim-sulfamethoxazole in MHB predicts the extent but not the rate of bacterial killing in human urine.
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It is debatable whether postoperative bacteriuria is the key parameter to define efficacy of antimicrobial prophylaxis in patients undergoing TUR-P. The rate of bacteriuria, however, correlated well with the overall rate of postoperative complications. Therefore, it seems reasonable to lower the rate of bacteriuria by prophylaxis. Since patients without antibiotic prophylaxis received at the end even more antibiotic doses than patients with prophylaxis, the overall selection pressure by antibiotic usage can obviously not be lowered by resigning prophylaxis. Therefore we conclude that at least patients at risk should receive antibiotic prophylaxis prior to TUR-P.
We report the case of a 77-year-old man who presented nasal obstruction sensation and epistaxis. Otorhinolaryngological examination revealed occupation of the left nasal passage and the left maxillary sinus by an inflammatory tumour, the biopsy results of which were inconclusive. While diagnostic tests where being carried out, the patient presented a severe systemic condition consisting mainly of anaemia, acute renal failure, and cavitated diffuse bilateral lung infiltrates. In the light of the results of anti-neutrophilic cytoplasmic antibodies and renal biopsy, Wegener's granulomatosis was diagnosed and treatment for the disease was instituted with a favourable response. Finally, clinical manifestations of Wegener's granulomatosis are reviewed, with especial emphasis on otolaryngologic complaints.
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Clinical and biological evaluation was performed every 30-60 days. End-points were PCP, toxoplasmosis and death. Adverse reactions were considered as defined in the protocol.
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A university-affiliated Department of Veterans' Affairs medical center HIV clinic.
Nocardia Asteroides infection in a non-immunocompromised pediatric patient is extremely rare. We present a case of ethmoid sinusitis and orbital subperiosteal abscess caused by N. asteroides with a 20 year follow up and a review of the literature. N. asteroides was grown from intraoperative cultures for mycobacteria following surgical incision and drainage of the abscess. Postoperatively, the patient received a seven month course of trimethoprim-sulfamethozaxole and had no subsequent sequelae. Nocardia infections are common in immunocompromised patients. We present what we believe to be the first case of pediatric Nocardia sinusitis with 20-year follow up.
Rhinoscleroma is a chronic granulomatous respiratory tract disease. The initial lesion site is often intra-nasal. Giant tumor presentations are rare. The authors report a case of extensive nasal rhinoscleroma.
Nocardia infections are uncommon in recipients of heart, lung, or heart-lung transplants, but such infections are well described. Frequent episodes of rejection, high-dose prednisolone treatment, renal impairment, and prolonged respiratory support have all been shown to increase the risk of Nocardia infection in this group. In this retrospective review of 540 recipients of heart, lung, or heart-lung transplants, 10 patients developed Nocardia infection (frequency, 1.85%). Infection occurred at a mean +/- standard deviation of 13+/-14.5 months after transplantation. All patients had pulmonary disease with no evidence of extrapulmonary disease. The Nocardia infection did not contribute directly to patient deaths. Coinfection with other pathogens was present in 6 patients, and 2 patients had sequential infections. Radiological findings varied. All isolates were susceptible to trimethoprim-sulfamethoxazole, amikacin, and imipenem. Treatment regimens varied. Two (30%) of 6 patients treated with trimethoprim-sulfamethoxazole developed adverse reactions, which necessitated a change in antibiotic therapy. The optimal treatment regimen, which comprises both the antimicrobial agent and the length of treatment, is unclear.
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To examine US secular trends in the resistance of AB in respiratory infections and blood stream infections (BSI) to antimicrobial agents whose effectiveness is supported in the literature