Urinary tract infections are amongst the most common pathogenic infections with an increasing resistance to antimicrobials. The objective of this study was to determine the etiology and antimicrobial susceptibility patterns of urinary tract infection pathogens isolated in Kosovo. A retrospective study was carried from urine samples of both inpatients and outpatients that were received in our laboratory throughout 2001. During the study period, 16500 urine samples were analysed, of which 4260 (25.8%) had significant bacteriuria obtained from 1420 patients. Of this, 1059 (74.6%) were collected from females and 361 (25.4%) from males. Urine samples processed from outpatients were 72.5% (1029), whereas 27.5% (391) were from hospitalised patients. Escherichia coli was the most common aetiologic agent isolated (80.5%), followed by Proteus spp. (6.1%), Klebsiella spp. (5.9%), Citrobacter (5.1%) and Mycobacterium tuberculosis (0.8%). Gram-positive bacteria accounted for only 0.3%. Pseudomonas aeruginosa was only isolated from inpatients and was responsible for 0.6% of infections. Amoxicillin, ampicillin and trimethoprim-sulphamethoxazole resistance rates were 48.7, 46.5 and 32.1%, respectively. Nitrofurantoin, cefalexin and ciprofloxacin expressed the highest susceptibility among these isolates. E. coli isolates from inpatients and outpatients showed more than 25% resistance to trimethoprim-sulphamethoxazole. Of all isolates, 16% (225) were resistant to three or more agents and considered multi-drug resistant. Current data on the prevalence of multidrug resistance among urinary tract isolates should be a consideration to change the current empiric treatment of urinary tract infections.
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Community-acquired respiratory infections in general, and those caused by S. pneumoniae in particular, are the main reason for prescribing antimicrobials in young children. Antibiotic drug abuse is common. This is the basis for the initiative for the reduction in antibiotic use. However, failure to consider that not all antibiotics are similar in their effect on promotion of resistance has led to continuous emerging resistance. In the present article, the trends in prescribing antibiotics in young children and their interrelation with antibiotic resistance among clinical respiratory isolates of S. pneumoniae in children will be reviewed, along with theoretical considerations and research evidence that led to concluding that among antibiotics, the least resistance-promoting drug for S. pneumoniae is amoxicillin (+/- clavulanate), whereas oral cephalosporins and azithromycin demonstrate a higher resistance-promotion potential in the individual population in the community. Although antibiotics differ in their resistant-promotion potential, all still do promote resistance.
The purpose of the present study was to propose a strategy for the selection of antibiotics that specifically target complexes of periodontal pathogens present in patients with periodontitis.
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The 7-day moxifloxacin-based triple therapy has a high eradication rate with fewer side-effects. This regimen can be a safe and effective option as second-line treatment for H. pylori infection.
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Helicobacter pylori infection has many different clinical outcomes. Not all infected persons need to be treated. Therefore, indications for treatment have to be clear, and several consensus guidelines have been formulated to aid the medical practitioner in this decision-making process. Triple therapy with a proton pump inhibitor (PPI), in combination with amoxicillin and clarithromycin is the established treatment of choice. For patients with penicillin hypersensitivity, metronidazole can be substituted for amoxicillin. Bacterial resistance to antibiotics is a major factor adversely affecting treatment success. Resistance to metronidazole has been reported in up to 80%, and resistance to clarithromycin in 2-10% of strains cultured. Resistance to either one of the antibiotics has been reported to result in a drop in efficacy of up to 50%. Emergence of resistance to both metronidazole and clarithromycin following failed therapy is a cause for concern; this underlines the need to use the best available first-line therapy. To avoid the emergence of resistance to both key antibiotics, the combination of metronidazole and clarithromycin should be avoided where possible. For failed treatment, several strategies can be employed. These include ensuring better compliance with repeat therapy, and maximizing the efficacy of repeat treatment by increasing dosage and duration of treatment, as well as altering the choice of drugs. Quadruple therapy incorporating a bismuth compound with a PPI, tetracycline and metronidazole has been a popular choice as a "rescue" therapy. Ranitidine bismuth citrate has been shown to be able to overcome metronidazole and clarithromycin resistance; it may be a useful compound drug to use in place of a PPI in "rescue" therapies. In the case of persistent treatment failures, it is useful to consider repeating gastroscopy and obtaining tissue for culture, and then prescribe antibiotics according to bacterial susceptibility patterns. It is also important in refractory cases to review the original indication for treatment and determine the importance of the indication.
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Intention-to-treat eradication rates were 79.0% and 78.0% for groups of standard sequential and levofloxacin-containing sequential therapy, respectively (P = 0.863). Per-protocol eradication rates were 84.9% and 81.3%, respectively, for these two therapies (P = 0.498). There were no significant differences between the groups in regard to the eradication rates and adverse events.
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Since the discovery of Helicobacter pylori in the early 1980s many treatment regimes have been developed to effectively treat this infection. International guidelines have allowed consensus on the best management and improved eradication rates. In recent years, increasing antimicrobial resistance has resulted in falling eradication rates with standard therapies. In this article, we review the most recent studies and guidelines in the treatment of H. pylori. Currently, the first-line treatment remains clarithromycin, amoxicillin or metronidazole and proton pump inhibitor twice daily, but a number of recent studies have shown low eradication rates with this treatment. Increased duration of therapy has been recommended to overcome the falling eradication rates. However, conflicting findings have been reported on the benefits of extending the length of traditional therapy. Sequential therapy may be an effective alternative to standard triple therapy in regions of increased antimicrobial resistance. Probiotics reduce side-effects from traditional regimens and may improve eradication rates. A quinolone-based second-line triple therapy appears to be effective and well tolerated. Bismuth-based quadruple therapy is also an effective alternative if available. In the future, regional antimicrobial resistance and eradication rates will determine the best treatment for H. pylori.
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Four-hundred and seventeen bacterial isolates were derived from sexually active or pregnant female outpatients (324 Escherichia coli) and pediatric patients (93 Klebsiella pneumoniae). We found a high prevalence of resistance towards the drugs used as "first-line" when treating UTIs: ampicillin, cotrimoxazole, and ciprofloxacin (79%, 60%, and 24% resistance, respectively). Ninety-eight percent of K pneumoniae isolates were resistant to ampicillin, whereas 66% of the E coli isolates were resistant to cotrimoxazole. Resistance towards third-generation cephalosporins was also high (6%-8% of E coli and 10%-28% of K pneumoniae). This was possibly caused by chromosomal β-lactamases, as 30% of all isolates were also resistant to amoxicillin/clavulanate. In contrast, 98% of the E coli isolates and 84% of the K pneumoniae strains (96% of all isolates) were found to be susceptible to nitrofurantoin, which has been in clinical use for much longer than most other drugs in this study.
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Nasal MRSA colonization occurs in some dental students, especially those who have clinical experience.
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A pilot clinical trial specially designed to test four different treatment regimens of Helicobacter pylori infection was performed among hospitalized and outpatient based patients in Clinical Centre University of Sarajevo, Gastroenterohepatology Clinics. Another objective was to assess Helicobacter pylori total cradication rates, partial cradication rates and after treatment persistent Helicobacter pylori infection rates among patients with clinically proven peptic ulcer disease (PUS). All patients randomly assigned into four groups had endoscopically and Helicourcasa test (HUT Astra) proven peptic ulcers. Each group was treated with one of the following four triple regimens: ranitidine + amoxicillin + metronidazole (RAM); ranitidine + clarithromycin + metronidazole (RCM); omeprazole + amoxicillin + metronidazole (OAM) and omeprazole + clarithromycin + m etronidazole (OCM). All triple regimens were given twice-a-day for one week following either ranitidine or omeprazole for two weeks depending of basic regimens. The highest Helicobacter pylori eradication was produced with OCM regimens (91.7%). Using same regimens we found the lowest partial eradication rate of all regimens (8.3%) and no persistency of H. pylori after the treatment. The lowest total eradication rate was found using RCM regimens (67.7%), while there was no difference in the cure rate between OAM (76.9%) and RAM (77.3%) regimens. If it is applicable, recommended treatment regimen as a first choice for proven H. pylori infection is OCM.
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The results of this study confirm that antibiotic self-medication is a relatively frequent problem in Abu Dhabi. Interventions are required in order to reduce the frequency of antibiotic misuse.