We performed a meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed and the Cochrane Central Register of Controlled Trials using a structured search strategy. The last date either database was accessed was November 14, 2007. We included RCTs that involved patients of any age with GAS tonsillopharyngitis, comparing short-course (< or =7 days) vs long-course (at least 2 days longer than short-course) treatment with the same antibiotics. The primary analysis compared 5 to 7 days with 10 days of treatment, using a random effects model.
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Milk culture results were retrospectively reviewed from 9007 cases of subclinical mastitis affecting cows housed in dairy herds located in New York and northern Pennsylvania. Cases included in this analysis had at least one mastitis pathogen isolated from the initial milk sample, were recultured within 1 mo, had permanent cow identification, and had records of whether mastitis was treated with an antibiotic or no treatment at all. Overall bacteriological cure rate for 21 mastitis pathogens was 68% (6097 of 9007). Antibiotic treated cases had a higher cure rate (75%) than did untreated cases (65%). Antibiotic treatments that significantly differed from the untreated cure rate of 65% were amoxicillin (82%), erythromycin (76%), cloxacillin (73%), and pirlimycin (44%). Cure rates for antibiotic treatments with cephapirin, hetacillin, or penicillin did not differ from the untreated cure rate. Agents for which some antibiotics were associated with increased cure rates compared with no treatment were Streptococcus agalactiae, streptococci other than Strep. agalactiae, and coagulase-negative staphylococci. The antibiotic most commonly associated with higher cure rates was amoxicillin. Most of the 21 mastitis agents showed no difference in bacteriologic cure rates between any of the 7 antibiotic treatments and no treatment.
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The species included in the Bacteroides fragilis group are the most frequent nontoxigenic anaerobic bacteria pathogenic to humans. The emergence and increase of resistance to antibiotics among this group make surveillance and state-of-the-art knowledge important. We studied the evolution of resistance to antibiotics in B. fragilis group organisms isolated at the University Clinical Hospital at Salamanca, Spain, from 1975 to 1987. No resistance to imipenem, chloramphenicol, or metronidazole was detected. The frequency of resistance to clindamycin was in the range of 6%-7%. Resistance to moxalactam, cefoxitin, mezlocillin, and piperacillin has increased steadily and is currently approximately 20%-25%.
The in-vitro effects of ten antimicrobial agents on the biofilm formation of Pseudomonas aeruginosa were investigated. The production of alginic acid by mucoid P. aeruginosa cells cultured in agar media with sub-MICs of antimicrobial agents was quantified by high-performance liquid chromatography. Alginic acid production was inhibited by 1/4 MIC of minocycline (P < 0.002) and tobramycin (P < 0.02), and by 1/256-1/1/64 MIC of macrolides (erythromycin, clarithromycin, roxithromycin, and rokitamycin) and clindamycin (P < 0.02), compared with drug-free controls. Piperacillin, ceftazidime, and ofloxacin did not inhibit alginic acid production. The production of exopolysaccharide by non-mucoid P. aeruginosa cells grown on silicone plates in sub-MICs of antimicrobial agents was determined by quantitative tryptophan assay. Exopolysaccharide production was inhibited by 1/16 MIC of macrolides and clindamycin, but not by other antimicrobial agents. Electron microscopy showed that biofilm formation by mucoid and non-mucoid type P. aeruginosa strains was inhibited by sub-MICs of erythromycin and correlated with the in-vitro production of alginic acid and exopolysaccharide. These results suggest that sub-MICs of macrolides and clindamycin suppress biofilm formation by P. aeruginosa and that intractable chronic respiratory tract infections due to P. aeruginosa might be prevented.
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The prevalence of Bordetella bronchiseptica in the nasal cavity of pigs and the in-vitro sensitivity of isolates to a variety of antimicrobial agents was investigated. B. Bronchiseptica was recovered from 372 nasal swabs collected from 1000 (37.2%) pigs slaughtered at 20-30 weeks old at an abattoir. The swabs were collected from groups of 5-206 pigs derived from 25 herds. All isolates tested against bacitracin, clindamycin, furazolidone, penicillin, spectinomycin, streptomycin and tylosin were found to be resistant. Of the 372 isolates tested against ampicillin and erythromycin 22 (6%) were sensitive to the former and 365 (98%) were moderately sensitive to the latter, the remainder were resistant. All isolates tested against neomycin and tetracycline were sensitive and with few exceptions, (2%), they were also sensitive to chloramphenicol. Overall, 259 of the 372 (70%) isolates were sensitive to sulphonamides, identical results being obtained with sulphadiazine, sulphafurazole and a trimethoprim-sulphamethoxazole combination. An association between in-vitro resistance to sulphanomides and extensive use of this group of drugs was demonstrated on three of eight farms investigated.
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To compare pneumococcal nasopharyngeal colonization rates among HIV-1-infected children with those of uninfected children born to seropositive mothers and those of seronegative controls. To determine the predominant serotypes and antimicrobial susceptibility among pneumococcal isolates in Kenya.
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Clostridium difficile is the most common cause of antibiotic-associated diarrhoea. Antibiotics are presumed to disturb the normal intestinal microbiota, leading to depletion of the barrier effect and colonization by pathogenic bacteria. This first step of infection includes adherence to epithelial cells. We investigated the impact of various environmental conditions in vitro on the expression of genes encoding known, or putative, colonization factors: three adhesins, P47 (one of the two S-layer proteins), Cwp66 and Fbp68, and a protease, Cwp84. The conditions studied included hyperosmolarity, iron depletion and exposure to several antibiotics (ampicillin, clindamycin, ofloxacin, moxifloxacin and kanamycin). The analysis was performed on three toxigenic and three non-toxigenic C. difficile isolates using real-time PCR. To complete this work, the impact of ampicillin and clindamycin on the adherence of C. difficile to Caco-2/TC7 cells was analysed. Overall, for the six strains of C. difficile studied, exposure to subinhibitory concentrations (1/2 MIC) of clindamycin and ampicillin led to the increased expression of genes encoding colonization factors. This was correlated with the increased adherence of C. difficile to cultured cells under the same conditions. The levels of gene regulation observed among the six strains studied were highly variable, cwp84 being the most upregulated. In contrast, the expression of these genes was weakly, or not significantly, modified in the presence of ofloxacin, moxifloxacin or kanamycin. These results suggest that, in addition to the disruption of the normal intestinal microbiota and its barrier effect, the high propensity of antibiotics such as ampicillin and clindamycin to induce C. difficile infection could also be explained by their direct role in enhancing colonization by C. difficile.
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Among S. pneumoniae isolates, 38.9% showed decreased susceptibility to penicillin (12.5% intermediate, 26.4% resistant) with marked geographical variability. The erythromycin resistance rate was 31.0% and highly correlated with penicillin resistance. The rate of fluoroquinolone resistance was 0.8%. Telithromycin was nearly uniformly active against S. pneumoniae (MIC(90) 0.5 mg/l). All isolates of S. pyogenes were penicillin-susceptible, 5.5% were resistant to erythromycin. Telithromycin minimum inhibitory concentrations (MICs) were lower than clindamycin and macrolide MICs against S. pyogenes (MIC(90) 0.03 mg/l versus 0.25 mg/l and 0.12 mg/l, respectively). 28.3% of H. influenzae isolates produced beta-lactamase. Telithromycin activity versus H. influenzae was not affected by beta-lactamase production.
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The effect of different antibiotic regimens for the treatment of postpartum endometritis on failure of therapy and complications was systematically reviewed.
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The present study revealed that GAS was the most predominant beta-haemolytic streptococcus among healthy Ethiopian school children. Our results showed that pharyngeal carriage of GAS in school children should not be underestimated. Therefore it is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimize GAS resistance.