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Azithromycin represents an alternative option to treat bacterial diarrhea when the antibiotic therapy is indicated. Little is known regarding the susceptibility to azithromycin in enteropathogens in Spain.
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Bacterial culture remains the gold standard for symptomatic infection. Nucleic Acid Amplification Tests (NAATs) have better sensitivity and specificity for rectal and pharyngeal specimens. A bacterial culture with antibiogram must be done for all NAAT positive specimens in order to modify antibiotics prescription if needed. We must fear a diffusion of extensively drug-resistant Neisseria gonorrhoeae in the future. Nevertheless, ceftriaxone 500 mg intramuscular with 1 g of azithromycin against Chlamydia trachomatis remains the treatment of N. gonorrhoeae infections. Screening of partners of identified cases and other STDs is the main measure to add to the treatment of gonorrhea.
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Double PCR could be used to accurately genotyping pI genes in all the tested gonococcal isolates with the sensitivity of 1 ng DNA template. In the 116 N. gonorrhoeae isolates, 30.2% (35/116) were pIA(+) strains and 69.8% (81/136) were pIB(+) strains. All the pIA(+) strains presented G120D/A121G double mutations (88.6%)or A121G single mutation (11.4%). 98.8% of the pIB(+) strains presented G120K/A121D (65.0%), G120K/A121G or G120N/A121D (13.8%) double mutations, and G120D/N/K single mutation (21.3%). 34.5% (40/116) of the isolates produced beta-lactamase, and the enzyme-produced rate (20%) in pIA(+) strains was significantly lower than that in pIB(+) strains (40.7%) with P < 0.05. No spectinomycin-resistant strains were identified but three ceftriaxone-resistant strains were presented. However, the resistance ratios to penicilin, tetramycin, ciprofloxacin and azithromycin of all the isolates were as high as 75.0% - 90.5%. 100% and 71.4% of the pIA(+) strains without beta-lactamase production and with G120 and/or A121 mutations were sensitive to penicillin and tetramycin, respectively. On the contrast, 100% of the pIB(+) strains without beta-lactamase production and with G120 and/or A121 mutations were resistant to both the two antibiotics.
Public health control of bacterial sexually transmitted infections (STIs) is dependent on the delivery of effective therapy and so will be compromised by the emergence of resistance. The scope of the problem and the implications for treatment that follow are discussed in this review.
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New developments in the treatment of bacterial infections are discussed. The most important developments include oral broad-spectrum cephalosporin derivatives and extended-spectrum injectable cephalosporins with improved activity against Gram-positive bacteria. Meropenem is a new carbapenem agent with markedly improved activity against Gram-negative bacteria. Many fluoroquinolones are in various phases of development. The most interesting new compound is sparfloxacin. Azithromycin is a new macrolide which, because of its very long half-life, attains very high levels in most tissues. Potential uses of the newer agents are discussed.
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Mycoplasma pneumoniae is a common pathogen for respiratory infection in children, and vascular complication is one of the rarest extrapulmonary complications but with serious consequences. We report a twelve-year-old Chinese female presenting with fever, dry cough, and chest pain aggravated by respiration. She was diagnosed pneumonia due to Mycoplasma pneumoniae and treated with Azithromycin until unexpected tachypnea and swelling in the right lower limb happened. Then ultrasonic examination had revealed two separated thrombi in deep veins before pulmonary embolism was found. Finally she was cured by anticoagulation and immunosuppressive therapy. Though the mechanism of thrombosis after Mycoplasma pneumoniae infection remains unknown, the positive finding in anticardiolipin antibody as well as multi-site thromboses gives a strong hint to immune modulation. Thrombosis should be considered for those who have significantly increased C-reactive protein and positive anticardiolipin antibody after Mycoplasma pneumoniae infection. To our knowledge, this is the first report describing two unattached thrombi in deep veins associated with pulmonary embolism after Mycoplasma pneumonia infection.