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Three cases of community-acquired pneumonia (CAP), requiring intensive care admission, are presented. The clinical picture of a "typical" bacterial pneumonia in the three patients led to an initial empirical treatment with amoxicillin clavulanic acid or 2(nd) generation cephalosporins. The treatment had to be changed in all three because of clinical failure. Erythromycin was added to the therapy with good clinical evolution. Serology confirmed atypical organisms to be responsible. Only the chest X-ray might have suggested an "atypical" or a "viral-like" agent. A proposition is made for an empirical combination of antibiotics in severely ill patients with CAP with more than unilobar consolidation.
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Annually 50,000 to 100,000 animal bites are seen by physicians in the Netherlands. Infections of these bite wounds frequently occur. Pasteurella multocida is one of the main causes of these infections and many serious complications may occur. We present 3 patients with disturbances in wound healing after animal bites or scratches due to infection with P. multocida. In view of the high infection ratio after cat bites we advise giving amoxicillin/clavulanic acid (Augmentin) for 5 days as prophylaxis. According to the literature prophylaxis for dog bites is not necessary. However, fatal complications after dog bites due to infections with Capnocytophaga canimorsus (DF-2) support those who prefer to give antibiotics after these bites also.
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Successful closure of thermal injuries, by either skin graft or delayed wound closure, largely depends on the ability to control the number of bacteria in the wound. The purpose of this study was to investigate the efficacy of two new antimicrobial agents, ticarcillin and clavulanate (Timentin) and amoxicillin and clavulanate (Augmentin), in the infected thermal injury. The therapeutic results were compared with the model treated with the standard topical silver sulfadiazine (Silvadene). Seventy-six Sprague-Dawley rats received a 20% full-thickness thermal injury and were then divided into six treatment groups. Three of the groups were inoculated topically with 10(8) Pseudomonas aeruginosa/ml, and three of the groups received topical inoculation of 10(8) Staphylococcus aureus/ml. The groups inoculated with P. aeruginosa received either intraperitoneal Timentin, topical Silvadene, or placebo treatment. The groups inoculated with S. aureus were treated with either enteral Augmentin, topical Silvadene, or placebo. The animals received 10 days of therapy and underwent tissue biopsies on alternate days. Statistical analysis showed that the level of bacteria in the wounds compared with the control group was significantly (p less than 0.05) decreased for both antibiotics tested as measured by quantitative wound biopsies. These studies demonstrate the efficacy of systemic Timentin and Augmentin in the infected thermal injury.
The aim of this study was to determine the efficacy of the lateral advanced flap in root-coverage procedures for mandibular incisors and to evaluate pain after treatment. A total of 15 patients who required treatment for gingival recessions were selected from the University of Genoa Laser and Restorative Dentistry Department. The inclusion criteria were the presence of at least one 3-mm gingival recession defect of a mandibular incisor and 3 mm or more of keratinized tissue width on the immediately adjacent tooth. One calibrated masked examiner performed the clinical measurements, including recession depth and width, probing depth, clinical attachment level, and keratinized tissue width. Patients were checked 7, 14, and 30 days after surgery and were included in supportive periodontal maintenance every 4 months. Further follow-ups were done at the first, third, and fifth year postsurgery when the same baseline assessment parameters were recorded according to the root-coverage esthetic score (RES). Numeric score recorded pain evaluations showed a mean of 3 at the day of the surgery, 2 in the first day after the surgery, and no significant scores were referred in the following days. Mean recession depth was 3.2 ± 1.3 mm at baseline; at 5 years, RES showed a positive increase of all scores. The laterally coronally advanced surgical technique was very effective in treating isolated gingival recessions. It combined the esthetic and root-coverage advantages of the coronally advanced flap with the increased gingival thickness and keratinized tissue associated with the lateral gingival flap.
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Cross-sectional survey research design.
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Ofloxacin exhibit a good activity against the pathogen bacteria of the respiratory tract, except for S. pneumoniae. Its use is interesting because it has a good diffusion into respiratory tissues. However, the combination with an another antibiotic was necessary to spread the activity spectrum and to prevent the resistant variants. By the new killing curve checkerboard method, these 2 combinations are studied against 8 strains: 4 H. influenzae (2 beta-lactamase producers), 2 S. pneumoniae and 2 K. pneumoniae, at 0, 2, 4, 6 and 24 hours, a viable bacteria counting is executed by a microdilution method and is subcultured with a Steers-type multiple inoculator. With K. pneumoniae, ofloxacin has a dose dependent bactericidal activity which is maximum at 1 mg/l, While augmentin has a time-dependent activity. In the combination the synergy is rare. With H. influenzae, the results are the same; the bactericidal activity is less rapid but it is better than the ones with amoxicillin and clavulanic acid. With S. pneumoniae, the 2 antibiotics have the same activity. No antagonism is observed. And the antibiotic which has a better bactericidal activity determine the viable bacteria count.
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Recurrent acute tonsillitis, peritonsillar infections and quinsy (peritonsillar abscess) are common clinical conditions that present to a general practitioner. Management in general practice and in hospital is confounded by apparently conflicting treatment options in the medical literature. We have developed clear guidelines as part of an ongoing audit cycle which include performing quinsy or 'hot' tonsillectomy in selected cases, alongside conservative treatments to ensure the speedy recovery and minimal hospitalisation of all patients, with resultant cost benefits.
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Trap-door fracture is frequent in childhood population. Clinical diagnosis can be difficult. However, surgical treatment should be considered before 24 hours to avoid complication as residual diplopia.
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Necrotising enterocolitis (NEC) was diagnosed in a term infant with Down's syndrome exposed to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapy.