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We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of antibiotic treatment for men and non-pregnant women with uncomplicated genital chlamydial infection? What are the effects of antibiotic treatment for pregnant women with uncomplicated genital chlamydial infection? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
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Most infections due to Gram-positive organisms can be treated with quite a small number of antibiotics. Penicillin, cloxacillin, and erythromycin should be enough to cover 90 per cent of Gram-positive infections. The relatively narrow spectrum of these drugs should be the incentive to prescribers to use them selectively, together with adequate bacteriological investigation, in order to achieve effective treatment with a minimum of disturbance to the patient's normal bacterial flora and without any other harmful side effects.
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A retrospective study of 52 cases of puerperal endometritis, clinically and microbiologically diagnosed over a 4-year period.
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Hypersensitivity adverse drug reactions are much more common among patients with acquired immunodeficiency syndrome (AIDS) than in the general population. High rates of hypersensitivity reactions to clindamycin have been noted. To investigate the role of reactive metabolites in these reactions, the authors studied toxicity of clindamycin and sulphamethoxazole (SMX) and their metabolites in uninfected and human immunodeficiency virus (HIV)-infected MOLT3 cells. Infected and uninfected cells were incubated with clindamycin or sulphamethoxazole hydroxylamine in increasing concentrations; reactive metabolites were generated by coincubation of cells and drug with murine microsomes and a microsomal activating system. Over a concentration range of 0 to 400 microM SMX-HA, there was a significant concentration-dependent increase in cell death in HIV-infected compared to uninfected cells (28%+/-3% vs 8%+/-5% at 400 microM, P < .05). In contrast, coincubation of cells with clindamycin, microsomes, and a microsomal activating system, as well as combinations of primaquine or pyrimethamine, was not associated with an increase in cell death among infected compared to uninfected cells. No concentration-toxicity was demonstrated. These data support the role of reactive metabolites in adverse drug reactions to sulfonamides during HIV infection, whereas alternate mechanism(s) may be responsible for increased rates of adverse drug reactions to clindamycin among patients with AIDS.
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Aztreonam is a synthetic monobactam antibiotic that has excellent activity against aerobic gram-negative bacilli. It can be used as a single agent for the treatment of upper urinary tract infections caused by organisms resistant to the cephalosporins and ampicillin. It also can be administered in combination with a drug such as clindamycin for treatment of pelvic inflammatory disease or postoperative pelvic infections.
Studies were categorized as treatments using antibiotics, biological agents, laser surgery, excisional surgery, or miscellaneous modalities. Of 62 publications included in the review, 4 studies met criteria to be assigned the highest grade for quality of evidence.
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An agar dilution method for susceptibility testing of anaerobic bacteria was evaluated to determine whether results obtained would be consistent enough to recommend it as a reference method. The study was conducted in 10 laboratories where the minimum inhibitory concentrations of six antibiotics (carbenicillin, cefoxitin, chloramphenicol, clindamycin, penicillin G, and tetracycline) were determined against 10 bacterial strains on Wilkins-Chalgren agar prepared by three manufacturers. Minimum inhibitory concentrations falling on the modes varied from 57 to 80% of all determinations and on the mode or within +/-1 log(2) dilution of the mode from 87 to 100% within each laboratory. When data from all laboratories were pooled, minimum inhibitory concentrations from each laboratory agreed with the overall mode 48 to 71% of the time, with an overall agreement at +/-1 log(2) dilution of 96%. This degree of reproducibility allows for recommendation of the procedure as a reference method. Results with three of the test strains were very consistent, and these strains are recommended as control strains: Clostridium perfringens ATCC 13124, Bacteroides fragilis ATCC 25285 and Bacteroides thetaiotaomicron ATCC 29741. The minimum inhibitory concentrations for these strains were on the mode or within +/-1 log(2) dilution of the mode 98, 99, and 99% of the time, respectively. The remaining anaerobic bacteria are recommended as reference strains.
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Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population. Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated, multidrug-resistant MRSA.
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The nephrotoxicity of netilmicin, an ethyl derivative of a dehydrogenated Cla gentamicin, was studied in Sprague-Dawley rats. Netilmicin toxicity was initially compared to gentamicin toxicity at equal doses across a broad range. These studies indicated that netilmicin was significantly less toxic than gentamicin. Netilmicin, gentamicin, tobramycin, amikacin, kanamycin, streptomycin, and sisomicin were then given to groups of rats at three dosage levels corresponding to 10, 15 or 25 times the recommended human dose on a weight basis daily for 15 days. Decreased urine osmolality, increased excretion of protein and Beta-n-acetyl hexosaminidase were dose related features of nephrotoxicity. All aminoglycosides accumulated in renal tissue. Streptomycin and netilmicin exhibited a flat dose response curve with respect to histologic damage, as compared to the other drugs. The examination of creatinine clearance and renal tissue suggested the following order of increasing toxicity: (1) controls, (2) streptomycin, (3) netilmicin, (4) tobramycin, (5) sisomicin, amikacin, and kanamycin, and (6) gentamicin. To assess the effect of non-aminoglycoside antibiotics on netilmicin nephrotoxicity, ampicillin, methicillin, carbenicillin, cefamandole, and clindamycin were given to groups of rats receiving netilmicin at either of two doses. These studies suggested that the nephrotoxicity was not affected by the administration of non-aminoglycoside antibiotics.
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Out of 171 S. aureus strains isolated from various clinical samples during September-December 2011 at Mashhad Emam Reza Hospital, 3 were cultured from eye discharge samples. Antimicrobial resistance tests were performed with MIC and disk diffusion methods and also genetic evaluation was done with Staphylococcal Cassette Chromosome mec (SCCmec), Accessory Gene Regulator (agr) and Staphylococcal Protein A (spa) typing, Multi Locus Sequence Typing (MLST) and determination of toxin gene profile.
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G. vaginalis is an important pathogen in the aetiology of bacterial vaginosis. Therefore, we investigated the influence of transport systems in isolation, a scoring system for Gram stains, and susceptibility to antimicrobial agents. The comparison between a simple (Transwab) and a sophisticated (Port-A-Cul) system showed no differences with regard to for instance Enterococcus faecalis or Escherichia coli; however, isolation of G. vaginalis, a fastidious microorganism, was significantly higher (alpha < 0.0001) in Port-A-Cul. There was a strong correlation (97.5%) using the scoring system indicating bacterial vaginosis and isolation of G. vaginalis. The minimal inhibitory concentrations (MIC) of metronidazole for 60 strains of G. vaginalis were higher than 32 mg/l, some strains showing heteroresistance. This phenomenon may be an explanation for treatment failures. Clindamycin and erythromycin were much more active, with MIC's between 0.016 and 0.19 mg/l, in-vitro development of resistance being slower for clindamycin than for erythromycin.
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States in 2002 on antimicrobial prescribing and associated rates of vancomycin-resistant enterococci (VRE) and Clostridium difficile infections.Design. Retrospective chart review.Setting. University-affiliated medical center. Measurements and Main Results. Microbiologic reports, patient demographics, and antimicrobial utilization were evaluated for patients admitted 6 months before the shortage (March 1-August 31, 2001) and for 6 months during the shortage (March 1-August 31, 2002). Significant increases in usage of alternative mu-lactamase inhibitor combinations, cefepime, levofloxacin, vancomycin, clindamycin, and metronidazole were observed during the shortage; in contrast, a significant decrease in the use of ceftriaxone took place. No change in the rate of VRE infection was observed from before to during the piperacillin-tazobactam shortage. However, a paradoxical 47% decrease in the rate of C. difficile colitis was documented during the shortage. Subsequent multivariate analyses suggested the reduced use of ceftriaxone and increased use of levofloxacin, but not the reduced use of piperacillin-tazobactam, correlated with the decreased rate of C. difficile infections.
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MOE induces changes in the genetic profile and protein expression patterns of P. intermedia that may also be linked to its drug resistance mechanisms.
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Antibiotic prophylaxis in elective colonic surgery is of established value and most authors have proposed an association of at least two drugs. We have compared the efficacy of classical prophylaxis (clindamycin and gentamicin, C + G) with that of the single drug cefoxitin (Ce). 101 consecutive patients were covered; 22 had to be excluded and 7 withdrawn after randomization; 72 cases were left for final analysis (C + G 35; Ce 37). Five C + G (14.2%) and 4 Ce cases (10.8%) developed septic complications, possibly caused by opening of the colon (wound infection, anastomotic failure, colocutaneous fistula): this difference is not statistically significant. Episodes of sepsis, urinary tract infection and pneumonia were similar in both groups. Although the number of patients included is relatively small, we conclude that prophylaxis with Ce alone appears to be as effective as double drug prophylaxis with C + G.
Community-associated methicillin-resistant Staphylococcus aureus infections are increasingly being documented worldwide. In Israel, however, CA-MRSA infections have not yet been reported, so awareness among physicians may be low.
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The recovery of Candida albicans along with bacteria from the abdomen in the setting of peritonitis is becoming increasingly common. It is not known whether the interactions between the fungal and bacterial elements of these infections are synergistic, competitive, or neutral. To study this question, we have examined the effects of both the addition of C. albicans to a solely bacterial infection caused by Escherichia coli and Bacteroides fragilis, and the deletion of various components of this system using directed antimicrobial therapy. In a mixed infection, both C. albicans and bacteria contributed to mortality, since only the combination of cefoxitin and amphotericin B improved survival (from 50% to 90%). The addition of C. albicans to the bacterial inoculum increased the recovery of abscesses, but only to the number seen with fungal infection alone, implying two fairly independent processes. Although the number of bacteria recovered from abscesses at 10 days postinfection was unchanged with the addition of fungi, the deletion of the bacterial component of mixed infections led to the overgrowth of C. albicans. We conclude that this model of mixed C. albicans/E. coli/B. fragilis peritonitis is best characterized as two nonsynergistic, parallel infections with incomplete competition, allowing the survival of all three organisms to eventual abscess formation.
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A total of 102 samples were collected from acne lesions and cultured onto sheep's blood agar and brain-heart infusion agar supplemented with 5 g/L glucose and 2 mg/L furazolidone) (BHIg) under aerobic and anaerobic conditions. Species identification was done by conventional methods and the VITEK2 Compact system. The isolates were tested for penicillin, erythromycin, clindamycin, ciprofloxacin, nadifloxacin, and tetracycline by E-test, and minimum inhibitory concentration (MIC) of minocycline was determined by agar dilution on BHIg. MIC results were interpreted as per EUCAST (European Committee on Antimicrobial Susceptibility Testing) and CLSI (Clinical Laboratory Standards Institute) guidelines.
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Isolates of erythromycin non-susceptible, clindamycin susceptible Staphylococcus aureus were identified. Routine antimicrobial susceptibility testing was performed using the Vitek-2 AST-P612 card, including the ICR test, and compared against the D-test.
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Methicillin-resistant Staphylococcus aureus bacteria are one of the key etiological factors of hospital-acquired and community-acquired infections. MRSA strains have an ability of causing a broad spectrum infections: from a relatively mild skin infections to severe life-threatening systemic infections. They are characterized by multi-drug resistance, virulence of a number of factors, may clonally spread within the hospitals and between hospitals.
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Resistance to MLS(B) and fluoroquinolone antimicrobial compounds is common among prevalent ribotypes of C. difficile. The genetic basis for antimicrobial resistance appears to be ribotype specific and conserved in the absence of recent antimicrobial selection pressure.
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A 20-year-old Chinese goose (Anser cygnoides) presented for severe left-sided head tilt and circling to the left. Peripheral vestibular disease associated with otitis media extending into the left quadrate bone was diagnosed by magnetic resonance imaging and computed tomography. Otoscopy confirmed a ruptured tympanic membrane, and a brainstem auditory evoked response test confirmed loss of hearing in the affected ear. Surgery to remove the caseous material and long-term medical therapy improved the bird's head tilt and quality of life. Otitis, hearing loss, and vestibular disease are rare in birds but can be managed after appropriate investigation. This is the first reported use of multiple advanced diagnostic tests and successful treatment of vestibular disease in a goose.