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We compared colonization and resistance rates of non-pneumococcal alpha-hemolytic streptococci (AHS) and Streptococcus pneumoniae in children receiving antibiotic therapy for acute otitis media.
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Empirical antibiotic therapy of community-acquired pneumonia (CAP) has been complicated by the worldwide emergence of penicillin resistance among Streptococcus pneumoniae. The impact of this resistance on the outcome of patients hospitalized for CAP, empirically treated with betalactams, has not been evaluated in a randomized study. We conducted a prospective, randomized trial to assess the efficacy of amoxicillin-clavulanate (2 g/200 mg/8 hr) and ceftriaxone (1 g/24 hr) in a cohort of patients hospitalized for moderate-to-severe CAP. Three-hundred seventy-eight patients were randomized to receive amoxicillin-clavulanate (184 patients) or ceftriaxone (194 patients). Efficacy was assessed on Day 2, after completion of therapy and at long term follow-up. There were no significant differences in outcomes between treatment groups, both in intention-to-treat and per-protocol analysis. Overall mortality was 10.3% for amoxicillin-clavulanate and 8.8% for ceftriaxone (NS). There were 116 evaluable patients with proven pneumococcal pneumonia. Rates of high-level penicillin resistance (MIC of penicillin > or = 2 microg/mL) were similar in the two groups (8.2 and 10.2%). Clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone (95% C.I. of the difference: -9.3 to +12.7%). No differences in outcomes were attributable to differences in penicillin susceptibility of pneumococcal strains. Sequential i.v./oral amoxicillin-clavulanate and parenteral ceftriaxone were equally safe and effective for the empirical treatment of acute bacterial pneumonia, including penicillin and cephalosporin-resistant pneumococcal pneumonia. The use of appropriate betalactams in patients with penumococcal pneumonia and in the overall CAP population, is reliable at the current level of resistance.
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A study was carried out to determine the pattern of in vitro antibiotic sensitivity of a cross section of the isolates of Pseudomonas aeruginosa recovered from diverse clinical sources during a one year period. One hundred and eighty-six isolates were investigated by disc diffusion method employing multidiscs. Majority of the isolates were sensitive to amikacin (89.7%), tobramycin (75.81%), norfloxacin (68.48%), piperacillin (68.25%), and ceftazidime (58.81%). Other antibiotics were effective for a lesser number of isolates. A few isolates were simultaneously resistant to several antibiotics, viz. gentamicin, carbenicillin, tobramycin, ceftazidime and augmentin. The significance of the findings is discussed.
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The incidence of antimicrobial resistance and expressed and unexpressed resistance genes among commensal Escherichia coli isolated from healthy farm animals at slaughter in Great Britain was investigated. The prevalence of antimicrobial resistance among the isolates varied according to the animal species; of 836 isolates from cattle tested only 5.7% were resistant to one or more antimicrobials, while only 3.0% of 836 isolates from sheep were resistant to one or more agents. However, 92.1% of 2480 isolates from pigs were resistant to at least one antimicrobial. Among isolates from pigs, resistance to some antimicrobials such as tetracycline (78.7%), sulphonamide (66.9%) and streptomycin (37.5%) was found to be common, but relatively rare to other agents such as amikacin (0.1%), ceftazidime (0.1%) and coamoxiclav (0.2%). The isolates had a diverse range of resistance gene profiles, with tet(B), sul2 and strAB identified most frequently. Seven out of 615 isolates investigated carried unexpressed resistance genes. One trimethoprim-susceptible isolate carried a complete dfrA17 gene but lacked a promoter for it. However, in the remaining six streptomycin-susceptible isolates, one of which carried strAB while the others carried aadA, no mutations or deletions in gene or promoter sequences were identified to account for susceptibility. The data indicate that antimicrobial resistance in E. coli of animal origin is due to a broad range of acquired genes.
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We determined minimum inhibitory concentrations of rifampicin, nitrofurantoin, amoxicillin-clavulanic acid, and cefdinir, plus a combination of amoxicillin-clavulanic acid and cefdinir by broth microdilution for mainly wound isolates of Escherichia coli and Klebsiella pneumoniae. E. coli and K. pneumoniae susceptibilities increased by combining amoxicillin-clavulanic acid and cefdinir.
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To characterize the pattern of surgical antimicrobial prophylaxis in the Czech Republic.
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Women were randomly assigned to receive amoxicillin-clavulanate (500 mg/125 mg twice daily) or ciprofloxacin (250 mg twice daily) for 3 days and were followed up for 4 months.
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Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.
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Regardless of the type of intracanal medicament used, Biodentine had significantly higher bond strength than MTA (P < 0.05). The highest push-out bond strength results were obtained in CH-treated dentine. Compared with other medicaments, this value was only significantly higher than that of Ledermix (P < 0.05). In both the MTA and Biodentine groups, pairwise comparisons between other medicaments showed similar debonding values (P > 0.05).
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Antibiotic susceptibility of ten bacteria i.e. Neisseria catarrhalis, Salmonella typhi, S. enteritidis, Haemophilus influenzae, Bacillus subtilis, Pseudomonas fluorescence, Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus and E. coli to twenty antibiotics i.e. cefpirom (30 mcg), ceftriaxone (30 mcg), erythromycin (15 mcg), doxycycline (30 mcg) lomefloxacin (10 mcg), sisomicin (30 mcg), vancomycin (30 mcg), augmentin (30 mcg), ampicillin (30 mcg), cotrimoxazole (25 mcg), cefotaxime (30 mcg), Chloramphenicol (30 mcg), cephalexin (30 mcg), tetracycline (30 mcg), ciprofloxacin (5 mcg), nitrofurantoin (300 mcg), nalidixic acid (30 mcg), pefloxacin (10 mcg), norfloxacin and ofloxacin (5 mcg) was studied to evaluate the antimicrobial efficacy of recently introduced second and third generation antibiotics. All the test strains were sensitive to pefloxacin, erythromycin, augmentin and chloramphenicol. Maximum resistance to cefpirom excluding E. coli and S. typhi and co-trimoxazole except S. typhi, Pseudomonas aeruginosa was observed, occasional resistance was seen against ceftriaxone, vancomycin and cefotaxime.