Fifteen kidney transplant recipients were treated with sirolimus 8-23 mg m(-2) in combination with azathioprine and prednisolone from the day of transplantation. Whole blood sirolimus AUC and C(max) were determined on days 6 and 7 after transplantation. On day 7, sirolimus was coadministered with the first dose of trimethoprim (80 mg) and sulphamethoxazole (400 mg).
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The principles behind the primary localization of lesions in fixed drug eruption are still unknown. Studies investigating the predilection areas indicated drug-related, trauma-related or inflammation-related specific site involvement in fixed drug eruption. This study presents new findings of primary site involvement on the maximal points of Head's zones. In the 3 cases reported here, fixed drug eruption lesions were located at specific sites; the so-called maximal points of Head's zones, which are known to be the most active dermatomal areas of an underlying visceral pathology. An underlying internal disturbance was found in all 3 patients, corresponding to the organ-related maximal point of Head's zones in each case. In conclusion, the primary location of the fixed drug eruption lesions on the maximal points of the Head's zones according to the well-known neurophysiological map is an important observation in studying the predilection areas.
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We evaluated the clinical and radiological features of PCP in 21 patients with malignancies and in 17 with AIDS. Clinical presentation, serum markers, oxygenation, CT findings, and outcome were examined.
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We found no significant difference between clindamycin and TMP-SMX, with respect to either efficacy or side-effect profile, for the treatment of uncomplicated skin infections, including both cellulitis and abscesses. (Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.).
Penicillin remains a satisfactory main treatment for gonorrhea in Uganda, but evidence exists that its usefulness is declining. Consequently, the evaluation of other drugs must continue. Trimethoprim used in combination with sulphamethoxazole has given promising results, and because the Kampala population has a fairly high incidence of gonorrhea and a good record of cooperation in followup examinations, it was decided to conduct and evaluation of this form of treatment. 109 male college students suffered 154 attacks of acute urethritis, gonococcal and nongonococcal, between January 1 and May 31, 1969; 80 had urethritis once, 19 twice, 5 thrice, 4 four times, and 1 five times. Of the 154 attacks, 141 were seen and treated, and only these were included in the survey. Of the 141 attacks, 107 were diagnosed as cases of gonorrhea; 92 were seen 1 within 1 week of sexual contact and 15 later; 91 were seen within 2 days of the appearance of discharge, 10 within 3-6 days, and 6 after 7 or more days. The source of infection was a casual acquaintance or prostitute in 76 cases, a continuing acquaintance or friend in 30, and the wife in 1 case. 12 patients had received treatment elsewhere before coming to the Students' Clinic. Tests of minimum inhibitory concentration (MIC) and disc-diffusion sensitivity tests of trimethoprim and sulphamethoxazole were performed on lysed horse-blood agar. Trimethoprim/sulphamethoxazole was given by mouth as "Bactrim drapsules" (Roche) each containing trimethoprim 80 mg and sulphamethoxazole 400 mg. Each dose consisted of 4 drapsules, i.e., trimethprim 320 mg plus sulphamethoxazole 1600 mg. In each schedule the 1st dose was taken in the presence of the doctor. Later doses were taken unsupervised at 12 hour intervals. Patients were asked to return 3 days, 1 week, 2 weeks, and 3 weeks after the end of treatment. At each visit, they were examined clinically. If there was any urethral discharge, smears and cultures were taken. 2 doses gave the unsatisfactory cure rate of 65%. 3 or 4 doses cured 96% of cases compared to the 91% cured by procine penicillin 2-4 mega units. Although the 3-dose and 4-dose schedules were equally effective in the trial, it is recommended that 4 doses be used in practice. This new drug combination has no advantage over tetracycline except that it needs only 3 or 4 doses instead of the 8 of tetracycline foung effective by Arya and Phillips (1970).
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Nine cases were identified. The mean patient age was 77.6 years, and the mean duration of therapy was 10.2 days. Seven patients received standard oral dosages of trimethoprim-sulfamethoxazole for common infections, and 2 patients were concurrently receiving angiotensin-converting enzyme inhibitors. The mean pretreatment levels of creatinine and potassium were 1.01 mg/dl and 4.55 mmol/l, respectively. The mean peak serum potassium level was 7.0 mmol/l. No deaths attributable to hyperkalemia occurred.
We describe a case of disseminated nocardiosis in a 45-year-old male with a history of chronic glomerular nephritis and allograft renal transplantation both treated with immunosuppressive drugs. Clinical symptoms included fever, chest distress, breathlessness, subcutaneous nodules and pustules. Pulmonary computed tomography scans revealed areas of consolidation in both lung fields, pleural effusion and massive pericardial effusion. Bacterial culture of the pus in the subcutaneous abscesses and pericardial effusion showed growth of Nocardia asteroides sensitive to linezolid and trimethoprim-sulfamethoxazole (TMP-SMZ) for both. Treatment with linezolid combined with TMP-SMZ resulted in a clear clinical improvement and bacterial clearance.
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The positive clinical response to doxycycline and aerosolized colistin seen in the patient described here suggests that this combination may be an alternative treatment in patients who fail initial treatment or cannot receive standard therapies.