All cases presented with pain and periocular erythema increasing over approximately 1 week. An S-shaped lid deformity was evident, and 2 of the 3 cases demonstrated multiple pustules/abscesses in the region of the lacrimal gland that were expressing purulent fluid into the superior fornix. Eye cultures yielded MRSA. Each case had complete clinical resolution with 2 to 4 days of intravenous vancomycin followed by 1 week of oral trimethoprim-sulfamethoxazole combination therapy.
Eighty-two gynecological patients with clinical signs of a lower urinary tract infection (UTI) were randomized to 10 days' treatment with either a fixed combination of pivampicillin-pivmecillinam (PAPM) or trimethoprim-sulphamethoxazole (TMPS). The effect of treatment could be evaluated in 25 patients on PAPM and in 19 on TMPS, who had bacteriologically verified UTI and who completed treatment and check-ups. All strains were sensitive in vitro to the respective antibiotic combination used. Treatment eradicated the original pathogen in 75-80% of the cases, 64% of the patients on PAPM and 47% on TMPS having sterile urine 3 weeks after end of treatment. Side effects could be evaluated in 76 patients. Two patients on PAPM and 8 on TMPS had to discontinue treatment due to side effects. Including abnormal values for hematology, liver and renal parameters, significantly fewer side effects (p = 0.038) were noted on PAPM (7/40) than on TMPS (15/36).
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Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.
Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.
This study was undertaken to determine the susceptibility of experimentally induced Spiroplasma mirum infection in the rat to trimethoprim/sulfamethoxazole (TMP/SMX) in combination with hyperbaric oxygen (HBO). One-day-old Fisher 344 rats were intracerebrally inoculated with the GT-48 strain of S. mirum and were exposed to regimens employed combined antibiotic and HBO treatments. The exclusive use of TMP/SMX produced a significant reduction in mortality (P less than 0.0001) and an absence of clinical signs of infection. HBO in combination with TMP/SMX showed similar effect on mortality and no evident clinical disease. The addition of HBO did result in a significant decrease in spiroplasma brain titres but was no more effective in preventing the spiroplasma-induced fatal microcystic encephalopathy than when the antibiotics were used alone. The exclusive use of HBO produced a catastrophic mortality rate in the spiroplasma-infected rats, which is contrary to the effect of HBO on conventional bacterial infections.
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To investigate the influence of empiric treatments prior to fiberoptic bronchoscopy (FOB) on the diagnostic yield of BAL in HIV-positive patients with respiratory symptoms.
The 337 patients enrolled had a mean age of 39.3 (standard deviation 10.3) years and 54.3% were female. TB treatment outcomes were distributed as follows: 205 (60.8%) treatment success, 99 (29.4%) deaths, 18 (5.3%) not evaluated, 14 (4.2%) lost to follow-up, and 1 (0.3%) failed. After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with a TB diagnosis made before 2010 (aOR = 2.50 [1.31-4.78]; p = 0.006), the presence of other AIDS-defining diseases (aOR = 2.73 [1.27-5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37-8.21]; p = 0.008), not receiving cotrimoxazole prophylaxis (aOR = 3.61 [1.71-7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18-5.08]; p = 0.016), and CD4 cells count <50 cells/mm3 (aOR = 16.43 [1.05-258.04]; p = 0.047).
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Fixed drug eruptions exclusively involving the genitalia of 60 male patients were investigated. Forty-two of the 60 patients completed tests designed to identify the causative drug. Tetracycline, aspirin, metamizole, and trimethoprim-sulfamethoxazole were found to be common etiologic agents. The sites affected were the glans penis, coronal sulcus, and preputial skin. Superficial ulceration or pigmented areas surrounded by an erythematous halo were the main clinical findings at the time of presentation.
Periodic surveillance of the antibiotic susceptibilities would be an important measure in detecting emergence and spread of resistance.
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A postpartum patient had a unilateral breast infection that responded to cephalosporin treatment. During therapy, the contralateral breast developed a methicillin-resistant Staphylococcus aureus infection. The patient was hospitalized and treated successfully with intravenous vancomycin. Obstetricians should be alert to this possibility when treating patients with postpartum mastitis.