A 60-year-old male with type C chronic hepatitis was admitted to Kibikogen Rehabilitation Center with high fever, cough and general fatigue. Chest X-ray film on admission showed consolidation in the left middle and lower lung lung field. Initial treatment with intravenous ceftazidime, imipenem/cilastatin and clindamycin were ineffective due to continuous high fever and cough and spread of the pneumonia shadow. Administration of minocycline was started for suspected non-bacterial pneumonia whereupon his symptoms improved and the pneumonia shadow began to decrease in size. However, his symptoms and pneumonia shadow worsened after taking him off of minocycline due to progressive pancytopenia and liver dysfunction. He was transferred to our hospital and intravenous erythromycin treatment was initiated for suspected Legionell pneumonia because of the elevation of Legionella micdadei serum antibody titer. Immediately after starting treatment, his symptoms improved and the pneumonia shadow decreased in size. Erythromycin was stopped after the 14th day of administration. In this case, diagnosis of L. micdadei pneumonia was made because of the positive results of the polymerase chain reaction test and elevation of the L. micdadei serum antibody titer (from 0 to 1,024). This is the second report of a L. micdadei pneumonia case here in Japan.
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A majority of subjects (82.6%) had grade 2-3 acne vulgaris at baseline; therefore these overall results may not be representative of the response in the subjects (17.4%) with grade 4-5 acne.
Clindamycin/primaquine is effective for treating mild-to-moderate cases of Pneumocystis carinii pneumonia (PCP) in patients with AIDS. We retrospectively reviewed our experience with this combination among patients in whom conventional therapy had failed or was not tolerated. Twenty-six patients who experienced 28 episodes of PCP received salvage therapy with clindamycin/primaquine at two university-affiliated medical centers. Clindamycin was administered intravenously, (usually 900 mg every 8 hours), after which oral therapy was instituted. Primaquine (30 mg) was given orally to all patients except three; two of these patients received 15 mg of the drug daily and another 30 mg of drug on alternate days. In 11 of the episodes, the patients received clindamycin/primaquine as initial therapy for PCP because of previous intolerance of conventional therapy. In 13 of the episodes, conventional therapy had failed or the patients were unable to tolerate the regimen, while in four episodes conventional therapy failed and the patients were unable to tolerate their therapeutic regimens. Twenty-four (86%; 95% confidence interval, 73%-99%) of 28 episodes were successfully treated with clindamycin/primaquine. The most common adverse effect was the development of an erythematous rash. Clindamycin/primaquine appears to be an attractive alternative for patients in whom standard therapy for PCP has failed or cannot be tolerated.
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This study examined the extent to which intervisit corticosteroid-based antibiotic pastes (CAP) medicaments contribute to staining of tooth structure after attempted removal by irrigation techniques.
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Surveillance of health-care associated infections in a setting with limited resources is challenging but feasible. Effective post-discharge surveillance was essential for the estimation of the incidence rate of SSSI following caesarean deliveries. This surveillance led to a peer-review of medical practices.
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Despite the fact that group A beta-hemolytic streptococci (GABHS) is always susceptible to penicillin, bacteriologic failure occurs in up to 20% of the patients treated with penicillin, and half of these cases are also a clinical failure. Various theories have been offered to explain this phenomenon. One explanation is that beta-lactamase-producing bacteria (BLPB) "shield" GABHS by inactivating penicillin. Beta-lactamase-producing bacteria were recovered from over 75% of the tonsils of patients who had tonsillectomy for recurrent infection. The absence of interfering aerobic and anaerobic organisms in many patients may also lead to failure of penicillin therapy in these individuals. Other explanations include noncompliance with a 10-day course of therapy, carrier state, re-infection, bacterial interference, GABHS intracellular internalization, and penicillin tolerance. Penicillin is still considered the antibiotic of choice for the therapy of GABHS tonsillitis. However, antibiotics other than penicillin were found to be more effective in eradicating the infection. These included cephalosporins (of all generations), clindamycin, macrolides, and amoxicillin-clavulanate. These agents were more effective than penicillin, especially in treating patients who failed previous penicillin therapy. Treatment of tonsillitis in patients who failed penicillin therapy is aimed at the eradication of the the BLPB that protect GABHS from penicillin, while preserving the oropharyngeal "protective" organisms. This review will describe the scientific and clinical data that demonstrate and explain the phenomena of beta-lactamase production and bacterial interference.
A 23-year-old Caucasian man diagnosed with stage IVB Hodgkin's disease was referred to a university oncology section after completing 1.5 cycles of chemotherapy. His chemotherapy consisted of doxorubicin HCL, bleomycin, dacarbazine, and vinblastine, with prophylactic administration of a granulocyte colony stimulating factor. He had developed postchemotherapy complications of possible cellulitis and necrotizing fasciitis that required wound debridement. The wound and tissue cultures were negative. Biopsies taken at the time revealed a dense inflammatory infiltrate consistent with an abscess. Over the course of 2 months, the wound healed with systemic antibiotics. The patient was reluctant to resume chemotherapy for his Hodgkin's disease because of his previous presumed skin infections. However, positive emission tomographic scanning revealed disease progression. Doxorubicin, bleomycin, dacarbazine, and prophylactic pegfilgrastim (a granulocyte colony-stimulating factor), were administered. Vinblastine was excluded from the new regimen. Shortly after chemotherapy and an injection of pegfilgrastim, the patient developed poorly defined, rapidly progressive erythema, edema, and pain in his right forearm. He presented to the emergency room, was evaluated by the orthopedics service, and taken to the operating room for debridement of suspected necrotizing fasciitis. When the dermatology service consulted the following day, the patient had developed an erythematous, edematous, tender plaque on his chest. After developing two additional lesions that began to ulcerate despite treatment with imipenem, vancomycin, clindamycin, rifampin, and gentamicin, the patient consented to a skin biopsy. His wound cultures continued to be negative.
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Clindamycin is a broad-spectrum antibiotic with activity against aerobic, anaerobic, and beta-lactamase-producing pathogens. This antibiotic has been used for many years as prophylactic treatment during dental procedures to prevent endocarditis. However, the spectrum and susceptibility of the bacteria species involved in dental infections indicate that clindamycin would also be an effective treatment option for these conditions. In addition to its antiinfective properties, clindamycin has high oral absorption, significant tissue penetration, including penetration into bone, and stimulatory effects on the host immune system. This review discusses the microbiologic and clinical evidence supporting the efficacy and safety of clindamycin for the successful management of dental infections.
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One-hundred sixty-two patients were evaluable; 81 received 1-day chemoprophylaxis, while the remaining 81 were treated according to the 3-day schedule. During the first 20 days after surgery, wound infections occurred in 2 (2.5%) and 3(3.7%) patients, respectively, in the 1-day and 3-day treatment groups, so that no significant difference was found among the two evaluated chemoprophylaxis schedules.
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A pilot-controlled-clinical-trial was carried out on hospitalized patients with cervicofacial odontogenic abscesses or cellulitis, who were randomly asigned to two study groups: 1) patients who received Moxifloxacin, and 2) patients receiving Clindamycin/Ceftriaxone combination. Infiltrate samples were collected through transdermic or transmucosal punction and later cultured on a media specific for aerobic and anaerobic microorganisms. Mean hospitalization duration in days until hospital discharge and susceptibility assessment in rates were established.
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The purpose of the study was to identify the bacterial composition of the microbiota from acute endodontic abscesses/cellulitis and their antimicrobial susceptibilities.
Streptococcus agalactiae (group B Streptococcus - GBS) remains a leading cause of neonatal infections and an important cause of invasive infections in adults with underlying conditions.