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Six groups, each containing 50 patients with acute maxillary sinusitis, were treated with ampicillin plus nasal decongestant, ampicillin plus irrigation, cephradine plus nasal decongestant, cephradine plus irrigation, erythromycinestolate plus nasal decongestant, erythromycinestolate plus irrigation. The diagnosis was radiologically established and the healing likewise radiologically assessed on the fifth, tenth and fifteenth day. Treatment was given for 10 days. All groups demonstrated a similar radiological healing except cephradine plus nasal decongestant which was inferior to the others. Contrarily, side effects were least frequent in the cephradine groups and most frequent in patients cured with ampicillin. The difficulty in choosing the best treatment is discussed in relation to such factors as therapeutic results, side effects, long-term consequences of antibiotic treatment, establishment of any bacterial etiology and penetration characteristics of antibiotics into the diseased sinus.
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Medicaid billing data from Michigan and Florida between 1980 and 1987.
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To determine the etiology of community-acquired pneumonia in ambulatory children and to compare responses to treatment with azithromycin, amoxicillin-clavulanate or erythromycin estolate.
Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis.
Reaction mechanism of macrolide 2'-phosphotransferase [MPH(2')] from Escherichia coli to the 2'-modified macrolide antibiotics was analyzed by using microbioassay, nuclear magnetic resonance (NMR) spectrometric assay and mass spectrometry. It was found by microbioassay that the 2'-modified macrolide antibiotics as triacetyloleandomycin (TAO), erythromycin ethyl succinate (EME) and erythromycin estolate were inactivated with adenosine triphosphate (ATP) by MPH(2'). The NMR spectrometric assay for the analysis of the reaction with the 2'-modified macrolide antibiotics and MPH(2') was established using guanosine triphosphate, which was higher reaction rate than ATP, as a cofactor. It was clearly shown by NMR spectrometric assay and mass spectrometry that the C2'-side chain of TAO and EME was naturally released in phosphate buffer solution, and then, the C2' position was phosphorylated with GTP by MPH(2').
Using prescription-event monitoring to determine whether erythromycin estolate was a more frequent cause of jaundice than erythromycin stearate or tetracycline 12 208 patients, for whom 5343 doctors had prescribed one of the three drugs, were identified by the Prescription Pricing Authority. Of the questionnaires sent to general practitioners about the possible occurrence of jaundice, 76% were returned. There were 16 reports of jaundice, of which four were attributable to gall stones, three to cancer, six to viral hepatitis, and only three were possibly related to an antibiotic. All three patients, in whom the antibiotic was a possible cause, had been treated with erythromycin stearate. No case was attributable to the estolate which had previously been suspected of being a more frequent cause of jaundice. Although the incidence is unknown, it is very unlikely to be more than one in 100.
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A study was performed to determine if the pharmacokinetics of bromocriptine is altered by factors that have been shown to interact with other ergot compounds. The effects on bromocriptine plasma concentrations by bromocriptine coadministration with caffeine and erythromycin were evaluated in five male volunteers. Serial blood samples were obtained during a 12-hour period after a single 5 mg oral dose of bromocriptine (alone and after 4-day treatments of either erythromycin estolate, 250 mg four times/day, or caffeine, 200 mg four times/day). There were no significant alterations of bromocriptine pharmacokinetic parameters after caffeine, although statistical power was very low. With the use of erythromycin, the bromocriptine area under the concentration-time curve standardized to body weight increased significantly by 268%, whereas peak bromocriptine plasma concentration (Cmax) increased to 4.6 times the Cmax from bromocriptine alone. Time to achieve Cmax was not altered by erythromycin. We conclude that erythromycin can markedly increase the systemic bioavailability of bromocriptine, which can lead to increased therapeutic or adverse effects, whereas the effects of caffeine require further study.
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Twenty-three patients with disseminated gonococcal infections--15 with acute tenosynovitis, six with septic monoarticular arthritis, and two with both--were randomly given five days of erythromycin stearate or estolate, 500 mg orally every six hours (13 patients), or crystalline aqueous penicillin G potassium, 1 million units intravenously every three hours for three days (ten patients). There were no treatment failures. Cultures taken one and seven days and two and four weeks after completion of therapy were uniformly negative. Clinical resolution was rapid in both groups, as judged by response of fever, joint tenderness, and disappearance of joint effusion. Orally administered erythromycin is a useful alternative to penicillin in the treatment of disseminated gonococcal infections, particularly in penicillin-allergic pregnant women.