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Sixty-two patients were identified for whom microbiology data were available. Six infections were classified as parapharyngeal on imaging; the remainder involved cervical chain lymph nodes. Forty-nine patients grew microorganisms on culture while 13 collections had no growth. The most common organism was S. aureus (63% of positive cultures); followed by beta-hemolytic group A Streptococcus (22%). Of S. aureus isolates, 27% were oxacillin-resistant (MRSA). All MRSA isolates were sensitive to clindamycin and trimethoprim/sulfamethoxazole; 63% were sensitive to ciprofloxacin, and 25% sensitive to erythromycin. Of methicillin-sensitive S. aureus isolates, 100, 86, and 82% were sensitive to trimethoprim/sulfamethoxazole, clindamycin, and ciprofloxacin, respectively. All MRSA isolates were identified during the latter half of the study period (2003-2006); none grew prior to 2003.
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Toxoplasmosis is a well-recognized life-threatening complication of hematopoietic cell transplantation (HCT). This report describes a pediatric patient with stage 4 neuroblastoma who developed cerebral toxoplasmosis after tandem high-dose chemotherapy with autologous HCT. Toxoplasmosis is rare in patients undergoing autologous HCT; however, tandem autologous HCT is more immunosuppressive than a single autologous HCT. Toxoplasmosis is a potential complication in autologous as well as allogeneic transplants, and should be considered in any post-HCT patient with neurological dysfunction. Rapid diagnosis and immediate antimicrobial treatment are crucial to avoid morbidity and mortality. Evaluation of toxoplasma serology should be standard in all patients undergoing tandem autologous HCT and seropositive patients should be started on appropriate prophylactic therapy.
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Nearly one fifth of human immunodeficiency virus-associated community-acquired bacterial pneumonias requiring hospitalization were caused by ampicillin-resistant pathogens, and presenting clinical characteristics did not consistently define a subset of patients at lower risk for resistance. In the absence of a diagnostic sputum Gram's stain and pending definitive microbiologic diagnosis, initial empiric therapy should be with a second- or third-generation cephalosporin or possibly trimethoprim-sulfamethoxazole.
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Low-dose TMP-SMX with methotrexate chemotherapy appears to be standard for patients with acute lymphoblastic leukemia; however, other uses appear questionable, and clinicians should be cognizant of the risk for fatal interactions, especially when medications are prescribed by multiple providers.
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An open retrospect study, including five patients, has been entered on, in order to estimate the efficacity and the tolerance in a more than sixty years old person, of the association ampicillin-cotrimoxazole for the treatment of the meningitis due to Listeria monocytogenes. In the infectious sphere, all the patients recovered; one death, by pulmonary embolism at the 21sh day of evolution, is to be deplored; two erythematous rashes have been observed. These preliminary results are encouraging and incite to carry on the evaluation of this protocol, which could replace the classical therapy; ampicillin-aminoglycosides, where only the ampicillin reaches effective concentrations on the level in the cerebro-spinal fluid.
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A total of 1,071 HIV-infected women from Kenya, Mozambique, and Tanzania were randomized to receive either three doses of IPTp-MQ (15 mg/kg) or placebo given at least one month apart; all received CTXp and a LLITN. IPTp-MQ was associated with reduced rates of maternal parasitemia (risk ratio [RR], 0.47 [95% CI 0.27-0.82]; p=0.008), placental malaria (RR, 0.52 [95% CI 0.29-0.90]; p=0.021), and reduced incidence of non-obstetric hospital admissions (RR, 0.59 [95% CI 0.37-0.95]; p=0.031) in the intention to treat (ITT) analysis. There were no differences in the prevalence of adverse pregnancy outcomes between groups. Drug tolerability was poorer in the MQ group compared to the control group (29.6% referred dizziness and 23.9% vomiting after the first IPTp-MQ administration). HIV viral load at delivery was higher in the MQ group compared to the control group (p=0.048) in the ATP analysis. The frequency of perinatal mother to child transmission of HIV was increased in women who received MQ (RR, 1.95 [95% CI 1.14-3.33]; p=0.015). The main limitation of the latter finding relates to the exploratory nature of this part of the analysis.
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We conducted a retrospective medical record review of 1876 patients evaluated in the emergency department of an urban community hospital from 2003 to 2012. Data regarding culture isolates and associated antimicrobial resistance, antibiotic treatment, site of specimen collection, age, race, and sex were collected and analyzed.