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Pseudomonas aeruginosa can rapidly acquire resistance to antibiotics, including fluoroquinolones and carbapenems.
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Linezolid is useful in treating complicated and uncomplicated skin and soft tissue infections caused by gram-positive bacteria. With precautions, including premedication, a monitored nursing unit, and immediate availability of an emergency anaphylaxis kit, drug desensitization allows patients the ability to safely use medications to which they may have an immediate hypersensitivity reaction. Minimal data exist on linezolid desensitization protocols.
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In a 5000-patient Monte Carlo simulation, pharmacodynamic analyses were performed for standard doses of cefepime, ceftazidime, ceftriaxone, ciprofloxacin, ertapenem, imipenem, levofloxacin, meropenem, and piperacillin/tazobactam. Prolonged 3-hour infusion regimens were also evaluated for anti-pseudomonal beta-lactams. MIC data were incorporated from the 2007 Meropenem Yearly Susceptibility Test Information Collection, a national surveillance study. The weighted cumulative fraction of response (wCFR) against common pneumonia pathogens was determined for each regimen. A second scenario was conducted by altering the pathogen prevalence to assess wCFR for late-onset pneumonia (ie, HAP in patients with prolonged mechanical ventilation). Optimal wCFR was defined a priori as >or=90%.
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Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial.
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Of the 10 study patients who were identified, clinical settings included trabeculectomy bleb-associated (n = 3), post-cataract surgery (n = 2), post-penetrating keratoplasty (n = 2), post-scleral buckle (n = 1), glaucoma drainage implant-associated (n = 1), and post-keratoprosthesis (n = 1). Clinical features included pain (n = 10) and hypopyon (n = 5). Presenting visual acuity was hand motions or worse in seven cases. All isolates were sensitive to gentamicin, ceftazidime, imipenem, and levofloxacin. The MIC 90s of isolates for antibiotics tested in the current period compared with isolates from January 1980 to June 1993 were unchanged. All isolates were resistant to vancomycin. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 8), pars plana vitrectomy with intravitreal antibiotic injection (n = 1), and evisceration (n = 1). When repeat vitreous fluid was obtained, persistent positive cultures were present in 1 (10%) of 10 patients in this study, compared with 5 (50%) of 10 patients in the previous study. Final visual acuity was no light perception in 6 of 10 patients (60%).
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To evaluate the efficacy of Integrative Chinese and western medicine (ICWM) in treating SARS.
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Carbapenem-resistant Enterobacteriaceae infections are becoming more common, are associated with high mortality rates, and are difficult to treat due to multiple mechanisms of resistance. We describe the successful treatment of Klebsiella pneumoniae carbapenemase-expressing Enterobacter cloacae empyema in a lung transplant recipient with cefepime and levofloxacin.
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S pneumoniae strains were 100% susceptible to quinolones and cotrimoxazole, 2% were resistant to macrolides, 11% were resistant to amoxicillin/clavulanic acid and 47% were resistant to cefuroxime. H influenzae was 100% susceptible to quinolones, azithromycin and amoxicillin/clavulanic acid. There was a 53% resistance to cotrimoxazole, 21% to amoxicillin, 9% to clarithromycin and 7% to cefuroxime. M catarrahalis was 100% susceptible to quinolones and 100% resistant to amoxicillin, 5% resistant to macrolides, 14% resistant to amoxicillin/clavulanic acid, 20% to cefuroxime and 30% to cotrimoxazole. Methicillin susceptible S aureus was susceptible to all antimicrobials and methicillin resistant S aureus was resistant to all.
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We determined the bacteriologic etiologies and antibiotic susceptibilities from wound cultures in the emergency department (ED). We hypothesized that in a suburban ED, MRSA would not represent the major pathogen.
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To analyze the changes of ocular bacterial isolates and their susceptibility to ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin and tobramycin in Henan Province in the past six years.
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Among 3444 administered courses of clarithromycin, erythromycin, azithromycin, ciprofloxacin, levofloxacin, or moxifloxacin, there were 1332 (38.7 %) with concomitant use of additional QT-prolonging drugs. Among those, we identified seven cases of drug-related QT prolongation, but 49.1 % had no ECG monitoring. Of all MQAB users, 547 (15.9 %) had hypokalemia. Forty-four MQAB users had contraindicated co-administrations of simvastatin, atorvastatin, or tizanidine and three of those related adverse drug reactions.
The therapeutic efficacy of oral treatment with levofloxacin, ciprofloxacin, and ampicillin on an experimental pneumonia caused by the penicillin-intermediate Streptococcus pneumoniae for which the minimum inhibitory concentrations (MICs) of the quinolones are similar was assessed in immunocompetent CBA/J mice. Levofloxacin exhibited a dose-dependent therapeutic effect, and achieved complete eradication of S. pneumoniae from the lungs at 120 mg/kg/day, whereas ciprofloxacin and ampicillin were hardly effective at all. A pharmacokinetic study in infected mice revealed good oral absorption and lung tissue penetration of levofloxacin (peak lung concentration: 5.95 microg/g of lung), low oral absorption of ciprofloxacin in spite of a good penetration into lung tissue (1.10 microg/g of lung), and low lung tissue penetration of ampicillin despite rather good oral absorption (1.71 microg/g of lung). In an in vitro time-kill study that simulated the peak concentration of drugs in the lungs of infected animals, the killing activity of levofloxacin was found to be greater than that of ciprofloxacin and ampicillin. These data suggest that the therapeutic efficacy of levofloxacin in this model is attributable to both its potent bactericidal activity and excellent pharmacokinetic profile.