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The frequency of trimethoprim (TMP)-resistant bacteria isolated from urine was studied in hospitals, in Stockholm, Sweden, and Turku, Finland. TMP has been in clinical use in Finland since 1973, whereas in Sweden TMP was available only in combination with sulphamethoxazole (SMZ) at the time for this study. All samples were collected solely from in-patients at 4 different occasions during a 20-month period 1977-78. The frequency of TMP-resistant strains (MIC greater than or equal to 8 micrograms/ml) in Turku increased from 31 to 49%, whereas it remained at a low level (1.6-3.6%) in Stockholm during the whole period. Also the frequency of TMP/SMZ-resistant strains (MIC greater than or equal to 64 micrograms/ml) increased in Turku from 24 to 45% but remained at the same level, 0-4% in Stockholm. In Turku there was also an increased frequency of resistance to SMZ (MIC greater than or equal to 512 micrograms/ml), ampicillin (MIC greater than or equal to 32 micrograms/ml) and nitrofurantoin (MIC greater than or equal to 64 micrograms/ml), while these frequencies remained at their initial levels in Stockholm. The distribution of bacteria was different in the two areas. In Turku there was also a change towards more nosocomial strains during the observation period. Since antibacterial agents are used more frequently in Turku than in Stockholm, this might be one explanation to the increase of resistance in Turku.
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Data from 41 patients, who received glucocorticoids with or without immunosuppressive agents and prophylactic use of TMP/SMX, were retrospectively analyzed. Thirteen patients were started on a daily dose of 10% of single-strength (SS) TMP/SMX, which was increased gradually (dose-escalation group), while 28 patients were started on 1 SS tablet daily (routine group).
resprim pediatric suspension
Children with complicated appendicitis were separated into two groups. Group 1 patients had had symptoms of complicated appendicitis for less than 72 hours or appeared toxic. Group 2 patients had had symptoms of complicated appendicitis for longer than 72 hours and did not appear toxic. Group 1 underwent immediate operation treated by criteria previously published. Group 2 patients were treated in hospital with triple antibiotics until they were afebrile, had normal white blood cell counts, tolerated an oral diet, and had adequate pain control. They were discharged on oral metronidazole or metronidazole plus Bactrim for 6 weeks and then underwent interval appendectomy.
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These preliminary results show that most patients who were thought to be intolerant to T/S and had no sulfamethoxazole-specific IgE can be safely desensitized and received the drug subsequently as an effective prophylaxis for PCP.
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Thymidine at levels as low as 0.05 mg/1 reduces the activities of sulphamethoxazole and trimethoprim and their combination in vitro. Using a biological assay procedure, levels of thymidine greater than this were interpreted as being present in urine. The addition of sulphamethoxazole and trimethoprim, singly or in combination, to urine obtained from patients with urinary tract infections showed that all the antibacterial effect towards sensitive organisms was due to the trimethoprim component. It is suggested that trimethoprim should replace the combination co-trimoxazole for the treatment of some lower urinary tract infections, and that laboratory media, if they are to resemble the clinical environment, should contain thymidine.
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Plasma levels and renal excretion of sulphonamide and trimethoprim following oral administration of co-trimazine (140 mg sulphadiazine + 90 mg trimethoprim) and co-trimoxazole (800 mg sulphamethoxazole + 180 mg trimethoprim) were monitored in healthy volunteers after a single dose and in the steady state after 12-hourly dosage. The plasma levels of free, non-protein bound components after co-trimazine were approximately half those after co-trimoxazole and thus correlated with the doses given. Urine recovery of trimethoprim was better after co-trimazine (70%) than after co-trimoxazole (58%). Sixty-six percent of the sulphadiazine was recovered as unchanged, active sulphonamide in the urine compared with only 13% of the sulphamethoxazole. Consequently, the sulphonamide levels of sulphadiazine were 2.5 times those of sulphamethoxazole. With respect to plasma half-life after the first dose, sulphadiazine with 8.0 hours was closer to trimethoprim with a half-life of 8.8 hours after cotrimazine and 9.6 hours after co-trimoxazole than to the half-life of sulphamethoxazole which was 7.7 hours. The distribution volume of sulphadiazine was closer to that of trimethoprim than was that of sulphamethoxazole. On the basis of these characteristics, it has been concluded that sulphadiazine is more suitable for a fixed combination tablet with trimethoprim than sulphamethoxazole, particularly for the treatment of urinary tract infections. Some renal tubular reabsorption occurs with both unchanged sulphonamides but is more pronounced with sulphamethoxazole. The solubilities of the sulphonamides and their acetylated metabolites at acid urinary pH indicate that therapy with co-trimazine is at least as safe as with co-trimoxazole. With the former drug, the result of scrutiny for crystals after dosage until the steady state was negative, whereas crystals of acetylated sulphamethoxazole were detected and verified chemically in two of eight subjects.
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Water of a recreational zone of the Río de la Plata was analyzed. Levels of total heterotrophic bacteria ranged from 1.5 x 10(3) to 6.2 x 10(3) CFU/ml and total coliforms were between 5.0 x 10(2) and 7.0 x 10(3) per 100 ml. Values of fecal coliforms were between 1.0 x 10(2) and 1.3 x 10(3) per 100 ml. Among 131 E. coli strains isolated, 20.6% of cephalothin resistance was found, followed by nitrofurantoin, ampicillin, sulfisoxazole and the trimethoprim sulfamethoxazole combination. Resistance to more than one antibiotic was found in 36.7% of the strains isolated and 9.2% were resistant to three or more antibiotics. Three strains resistant to four antibiotics and one resistant to five were isolated. The highest percentage of combined resistance occurred for the pairs cephalothin-nitrofurantoin and cephalothin-ampicillin.