The majority of clinicians follow the American Heart Association (AHA) guidelines with a single oral preoperative dose of 2 g amoxycillin or 600 mg clindamycin if patients are allergic to penicillin. From the literature and the data obtained by questionnaire, it would appear that renal patients receiving haemodialysis in Australia and New Zealand receive antibiotic prophylaxis prior to invasive dental procedures. The standard single dose of 2 g amoxycillin orally or 600 mg clindamycin orally 1 h preoperatively, as recommended by the AHA, is most frequently used. Peritoneal dialysis patients generally do not receive a prophylactic dose of antibiotics.
Trace levels of antibiotics in treated wastewater effluents may present a human health risk due to the rise of antibacterial activity in the downstream environments. Advanced oxidation has a potential to become an effective treatment technology for transforming trace antibiotics in wastewater effluents, but residual or newly generated antibacterial properties of transformation products are a concern. This study demonstrates the effect of UV photolysis and UV/H2O2 advanced oxidation on transformation of 6 antibiotics, each a representative of a different structural class, in pure water and in two different effluents and reports new or confirmatory photolysis quantum yields and hydroxyl radical rate constants. The decay of the parent compound was monitored with HPLC/ITMS, and the corresponding changes in antibacterial activity were measured using bacterial inhibition assays. No antibacterially active products were observed following treatment for four of the six antibiotics (clindamycin, ciprofloxacin, penicillin-G, and trimethoprim). The remaining two antibiotics (erythromycin and doxycycline) showed some intermediates with antibacterial activity at low treatment doses. The antibacterially active products lost activity as the UV dose increased past 500 mJ/cm(2). Active products were observed only in wastewater effluents and not in pure water, suggesting that complex secondary reactions controlled by the composition of the matrix were responsible for their formation. This outcome emphasizes the importance of bench-scale experiments in realistic water matrices. Most importantly, the results indicate that photosensitized processes during high dose wastewater disinfection may be creating antibacterially active transformation products from some common antibiotics.
Community-acquired, methicillin-resistant (CA-MRSA) infections in children are increasing in frequency for unknown reasons.
Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. This improvement can be achieved by formulating a stepwise approach that consists of early provision of time-sensitive interventions such as: aggressive hydration (20 mL/kg of normal saline over the first hour), initiation of appropriate empiric intravenous antibiotics (gentamicin, clindamycin, and penicillin) within 1 hour of diagnosis, central hemodynamic monitoring, and the involvement of infectious disease specialists and critical care specialists familiar with the physiologic changes in pregnancy. Thorough physical examination and imaging techniques or empiric exploratory laparotomy are suggested to identify the septic source. Even with appropriate antibiotic therapy, patients may continue to deteriorate unless septic foci (ie, abscess, necrotic tissue) are surgically excised. The decision for delivery in the setting of antepartum severe sepsis or septic shock can be challenging but must be based on gestational age, maternal status, and fetal status. The natural inclination is to proceed with emergent delivery for a concerning fetal status, but it is imperative to stabilize the mother first, because in doing so the fetal status will likewise improve. Aggressive [corrected] treatment of sepsis can be expected to reduce the progression to severe sepsis and septic shock and prevention strategies can include preoperative skin preparations and prophylactic antibiotic therapy as well as appropriate immunizations.
A search of 8 years of electronic records identified children with osteoarticular infections. Only children with culture-positive acute bacterial arthritis (ABA) or acute bacterial osteomyelitis (ABO) were studied further. A primary chart review of demographic and clinical data was conducted, and a secondary chart review of complicated outcomes was performed.
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The development of streptococcal fasciitis depends on the inoculation of a susceptible individual (i.e. one who has not been previously exposed to that particular serotype or superantigen) with a virulent streptococcus that has the ability to produce superantigens. The superantigens produce an excessive stimulation of the immune system, with a subsequent outpouring of inflammatory cytokines causing the multiorgan failure that characterises both streptococcal necrotising fasciitis as well as streptococcal toxic shock syndrome. Effective management of streptococcal necrotising fasciitis requires an early diagnosis, appropriate surgery, administration of clindamycin (600 mg/70 kg i.v. 6-hourly), penicillin G (1.2 g/70 kg i.v. 2 to 4-hourly), and polyvalent immunoglobulin (0.2 - 0.4 g/kg/day i.v. for 3 - 5 days). Household and health workers in close contact with the patient need to be warned to present to medical care early if they develop any signs of an infection.
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Adamantiades-Behçet's disease was diagnosed in a 42 year old Turkish patient with recurrent oral aphthae, genital ulcerations, papules, and sterile pustules, histologically presenting as cutaneous vasculitis, and intermittent arthritis with joint effusion particularly of the knees. Six months after initial improvement under treatment with colchicine 2 mg/day, a solitary genital ulcer with enlarged inguinal lymph nodes appeared and persisted for 7 weeks despite the continuation of colchicine treatment and the introduction of clindamycin 2 mg/day intravenously. The unusual persistence of the ulcer and the failure of clindamycin therapy led to further differential diagnostic considerations and the identification of primary syphilis. The genital lesion healed 4 weeks after initiation of treatment with tetracycline 2 mg/day by mouth for 15 days.
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The physical compatibility of various drugs with neonatal total parenteral nutrient (TPN) solution during simulated Y-site administration was evaluated.
The comparative pharmacokinetics and serum inhibitory effects of clindamycin were evaluated in six healthy male subjects given multiple-dose infusions of the following regimens in a crossover fashion: 600 mg every 6 h, 900 mg every 8 h, and 1,200 mg every 12 h. Serial blood samples were obtained after the last dose in each regimen and analyzed for clindamycin by a sensitive and specific high-performance liquid chromatography assay technique. Clindamycin pharmacokinetics were estimated by using noncompartmental methods, and serum inhibitory titers were serially determined against Bacteroides fragilis ATCC 25285 and evaluated by using area under the serum inhibitory curve (AUIC). Maximum and minimum concentrations in plasma averaged 12.2 +/- 1.6 and 1.2 +/- 0.6, 16.3 +/- 4.0 and 0.9 +/- 0.5, and 16.8 +/- 2.5 and 0.4 +/- 0.2 micrograms/ml for the 600-, 900-, and 1,200-mg regimens, respectively. Clindamycin plasma clearance and elimination half-life averaged 23.3 +/- 4.0 liters/h and 1.9 +/- 0.4 h for the 600-mg regimen, 25.6 +/- 8.2 liters/h and 2.1 +/- 0.4 h for the 900-mg regimen, and 26.4 +/- 4.7 liters/h and 2.1 +/- 0.4 h for the 1,200-mg regimen. These results were not significantly different. Apparent volume of distribution increased significantly for the 1,200-mg regimen compared with the 600-mg regimen. Mean maximum reciprocal serum inhibitory titers were 96 +/- 35, 101 +/- 43, and 160 +/- 78 for the 600-, 900-, and 1,200-mg regimens, respectively. Minimum reciprocal serum inhibitory titers averaged 12 +/- 4, 6 +/- 3, and 5 +/- 2 for the low-, medium-, and high-dose regimens, respectively. Mean AUIC increased roughly in proportion to dose. Similar daily values for the area under the concentration-time curve and for AUIC for each of the regimens suggest similar daily drug exposure and serum inhibitory activity. A regimen of 1,200 mg every 12 h may represent an alternative dosing strategy for clindamycin.