Reduced Posology of an Ophthalmic Hydrogel Containing Dexamethasone/Netilmicin to Prevent and Treat Ocular Inflammation After Cataract Surgery: Efficacy and Tolerability.

INTRODUCTION: To demonstrate efficacy and safety of an ophthalmic hydrogel formulation of netilmicin/dexamethasone, containing xanthan gum twice a day (b.i.d.) versus netilmicin/dexamethasone eye drops four times a day (q.i.d) to treat inflammation and prevention of infection after cataract surgery. METHODS: Patients undergoing phacoemulsification with intraocular lens implantation (IOL) were randomised in two groups: group 1, twice daily (b.i.d.) dexamethasone 0.1%/netilmicin 0.3% (Netildex) ophthalmic gel; group 2, four times daily (q.i.d.) dexamethasone 0.1%/netilmicin 0.3% (Netildex) eye drops. Both treatments were administered for 14 days after surgery. Patients were evaluated before surgery, on the day of surgery and at 1, 7, 15 and 60 postoperative days. The primary efficacy endpoint was evaluation of cellularity and flare in the anterior chamber through slit-lamp biomicroscopy 7 days after surgery. Secondary endpoints included: presence of signs/symptoms of postoperative ocular inflammation and incidence of infection. RESULTS: One hundred seventy-three patients were randomised and 168 were evaluable. Flare and cellularity were resolved at day 7 in 92.5% of patients and almost completely by day 15. In both intent to treat (ITT) and per-protocol (PP) populations, the efficacy analysis demonstrated that the gel formulation administered twice a day was non-inferior to the eye drops administered four times a day. For ITT analysis, the lower limit of the 97.5% confidence interval (- 0.0535) was greater than the non-inferiority limit of -0.10. For the PP analysis, the lower limit of the 97.5% confidence interval (- 0.0526) was greater than the non-inferiority limit of - 0.10. The patient's global tolerability and reported symptoms were similar between treatment groups. No microbial load and no safety events were observed. CONCLUSIONS: Efficacy of the gel reduced posology (twice a day) is not inferior to four times a day eye drops. Both treatments were well tolerated and efficacious. The new reduced posology hydrogel formulation may improve patient compliance and quality of life. TRIAL REGISTRATION: Eudract: 2016-0021138-63; ClinicalTrial.gov: NCT029738880.

Orofacial space infections, etiology, microbiological susceptibility and surgical management / Infecciones del espacio orofacial, etiología, susceptibilidad microbiológica y manejo quirúrgico

Orofacial infections are considered as one of most common infections and need rapid and adequate treatment as they affect a very delicate region and are associated with serious life-threatening complications. Orofacial infections can be either odontogenic that is with an origin in teeth and associated structures or non-odontogenic, not associated with teeth, can affect facial spaces and spread from one space to another, so a good knowledge about diagnosis and treating these infections is of utmost importance, and can include both non-surgical and surgical treatment. The aim of our study was to determine the most common cause of orofacial infections, the most common bacterial microorganisms and their antibiotic susceptibility. Materials and Methods: A descriptive study was undertaken in the Department of Oral and Maxillofacial Surgery, Al-Shaheed Ghazi Al-Hariry Hospital, Baghdad, Iraq from 1st January to 30th September 2015. This study included 45 patients with different forms of orofacial infections; data regarding age, gender, underlying cause, facial space involvement, presenting signs were collected through history, clinical examination and radiographs, incision and drainage with swab sample for culture and sensitivity test was performed. Results: Patients with orofacial infections showed a female to male ratio of 1.25:1. The mean age was 32.8 years. Most of the patients were in their 4th decade of life (27%). Most infections were odontogenic in origin (62%), the most common facial space involved was submandibular (65%), the most common isolated microorganism was Streptococcus pyogenes (59%), and most patients were treated using an extra-oral surgical approach (78%). Antibiotics to which bacterial isolated showed the most sensitivity were netilmicin, cefoperazone and rifampicin (91%). Pain and limitation of mouth opening gradually decreased in most of patients during the two weeks follow up period. Conclusion: Orofacial infections were more common in females, in the third and fourth decade of life, were odontogenic in origin, were mostly caused by Streptococcus pyogenes, and most isolates were susceptible to netilmicin, cefoperazone and rifampicin. Pain and trismus decreased over two weeks post-treatment.

Las infecciones orofaciales se consideran una de las infecciones más comunes y necesitan un tratamiento rápido y adecuado, ya que afectan una región muy delicada y se asocian con complicaciones graves que amenazan la vida. Las infecciones orofaciales pueden ser odontogénicas que se originan en los dientes y las estructuras asociadas, o no odontogénicas, no asociadas con los dientes, pueden afectar los espacios faciales y propagarse de un espacio a otro, por lo que un buen conocimiento sobre el diagnóstico y el tratamiento de estas infecciones es de suma importancia, y puede incluir tratamiento no quirúrgico y quirúrgico. El objetivo de nuestro estudio fue determinar la causa más común de infecciones orofaciales, los microorganismos bacterianos más comunes y su susceptibilidad a los antibióticos. Material y Métodos: se realizó un estudio descriptivo en el Departamento de Cirugía Oral y Maxilofacial, Hospital Al-Shaheed Ghazi Al-Hariry, Bagdad, Iraq del 1 de enero al 30 de septiembre de 2015. Este estudio incluyó a 45 pacientes con diferentes formas de infecciones orofaciales; Se recopilaron datos sobre edad, sexo, causa subyacente, afectación del espacio facial, signos de presentación a través de la historia, examen clínico y radiografías, incisión y drenaje con muestra de hisopo para cultivo y prueba de sensibilidad. Resultado: Los pacientes con infecciones orofaciales mostraron una relación mujer/hombre de 1.25: 1. La edad media fue de 32,8 años. La mayoría de los pacientes estaban en su cuarta década de vida (27%). La mayoría de las infecciones fueron de origen odontogénico (62%), el espacio facial más común involucrado fue submandibular (65%), el microorganismo aislado más común fue Streptococcus pyogenes (59%), y la mayoría de los pacientes fueron tratados con un abordaje quirúrgico extraoral (78%). Los antibióticos a los que las bacterias aisladas mostraron mayor sensibilidad fueron netilmicina, cefoperazona y rifampicina (91%). El dolor y la limitación de la apertura de la boca disminuyeron gradualmente en la mayoría de los pacientes durante el período de seguimiento de dos semanas. Conclusión:Las infecciones orofaciales fueron más comunes en las mujeres, en la tercera y cuarta década de la vida, fueron de origen odontogénico, fueron causadas principalmente por Streptococcus pyogenes y la mayoría de los aislamientos fueron susceptibles a la netilmicina, cefoperazona y rifampicina. El dolor y el trismo disminuyeron durante las dos semanas posteriores al tratamiento.

Loss of cutaneous microbial diversity during first 3 weeks of life in very low birthweight infants.

Neonatal sepsis (NS) is a frequent problem in neonatal intensive care, especially in preterm and very low birthweight (VLBW) infants. The objective of the study was to characterize the cutaneous bacterial microbiome in VLBW infants treated in the neonatal intensive care unit (NICU). Non-invasive skin microbiome specimens were taken repeatedly from 12 VLBW infants during treatment in NICU starting on the first day of life. All infants received benzylpenicillin and netilmicin during the first 1-5 postnatal days. Samples were also collected from incubators. High cutaneous microbial diversity was present at birth in 11 of 12 of the infants, but the diversity decreased substantially after the first weeks of life in all infants regardless of their infection status. After the loss of diversity, one Staphylococcus operational taxonomic unit dominated the skin microbiome. Recovery of microbial diversity was seen in six of 12 neonates. The microbiome of incubators showed typical environmental bacterial genera. Maternal antibiotic treatment, the aetiology of the preterm birth or being born by C-section did not appear to affect the diversity of skin microbiota at birth, and no correlation was found between cutaneous microbiome and NS.

Microbiological spectrum and susceptibility pattern of clinical isolates from the neonatal unit in a single medical center.

BACKGROUND: Infections are a frequent and significant cause of morbidity and mortality in neonatal units. The bacterial pathogens and their susceptibility patterns should be monitored in hospital settings. The aim of the study was to describe the distribution of the bacterial agents and their antibiotic resistant and susceptibility patterns in the Special Neonatal Care Unit (SNCU). MATERIAL AND METHODS: A retrospective analysis of results of microbiologically tested samples (blood, cerebrospinal fluid, urine, stool, eye excretions, external ear swabs, nasopharyngeal swabs and skin swabs) taken from newborns hospitalized in one SNCU in Warsaw (Poland) was conducted. The period analyzed was from July 1st, 2010 to December 31st, 2010. RESULTS: A total of 838 cultured samples were collected in the period analyzed. Three hundred seventy three of them (44.5%) were positive. The majority of the cultured microorganisms were classified as colonization: 338/373 (91%) strains. Gram negative bacteria were predominant colonizing flora: 227/338 (67%) strains. Gram positive bacteria were predominant causative agents in newborns with infections: 26/35 (74%) strains. 57.9% of Escherichia coli isolates were resistant to amoxicillin and ampicillin. 100% of Klebsiella pneumoniae were resistant to amikacin and netilmicin. Staphylococcus aureus methicillin resistant strains were cultured in 2.7% of cases. CONCLUSIONS: Gram negative species continue to be predominant agents of neonatal colonizing flora while gram positive bacteria remain important causative agents for symptomatic infections. Continuous monitoring of bacterial flora and its antibiotic susceptibility pattern is necessary to provide a successful antibiotic policy. Current results may be used for future national and international comparison.

Bloodstream infection with Oligella ureolytica in a newborn infant: a case report and review of the literature.

Oligella species are small, Gram-negative, nonsaccharolytic aerobic rods or coccobacilli that are catalase and oxidase-positive, mostly isolated from the urinary tract and rarely from wounds, bloodstream infections, septic arthritis, or peritonitis.In this article, we report a case of O.ureolytica-related bloodstream infection in a newborn infant and we review the literature for previously reported cases of Oligella infections.

Acquired Bartter-like syndrome association with netilmicin therapy in an extremely low birth weight infant.

Aminoglycosides are commonly used antibiotics with excellent renal parenchymal penetration. Their clinical effectiveness is counter balanced with the risk of renal toxicity, which develops in a dose-dependent fashion. Aminoglycoside-induced renal tubular dysfunction could result in diffuse damage or manifest as a Fanconi-like syndrome, Bartter-like syndrome (BLS), or distal renal tubular acidosis.(1-4) Although tubulopathy associated with amikacin and gentamicin was reported in adults and rarely children, to the best of our knowledge, netilmicin-associated BLS neither in adults nor in children has been reported in the literature. We here report a 30-week, 770 g male preterm infant who developed BLS just after netilmicin treatment for neonatal sepsis and recovered 6 weeks after the drug cessation.

'Leptotrichia amnionii', a newly reported cause of early onset neonatal meningitis.

'Leptotrichia amnionii' is an underestimated fastidious inhabitant of the vaginal flora that can cause upper genital tract infections when predisposing factors are present. We describe here what is believed to be the first reported case of early onset meningitis due to 'L. amnionii' in a neonate with intrauterine growth retardation. The outcome was favourable after cefotaxime treatment.

Bacteroides fragilis vertebral osteomyelitis complicated by percutaneous epidural adhesiolysis.

STUDY DESIGN: A case report of anaerobic vertebral osteomyelitis after percutaneous epidural adhesiolysis. OBJECTIVE: To present a case of Bacteroides fragilis spondylodiscitis (BFS) secondary to percutaneous epidural adhesiolysis in a 38-year-old woman without predisposing factors. SUMMARY OF BACKGROUND DATA: Most cases of BFS result from hematogenous spread from a perianal abscess or sigmoidoscopy or local spread from an adjacent infection. However, BFS due to direct inoculation after percutaneous epidural adhesiolysis has not been previously reported. METHODS: A 38-year-old woman presented with spondylodiscitis at the L4-L5 level 2 weeks after percutaneous epidural adhesiolysis. Despite empirical antibiotherapy, the spondylodiscitis and an epidural abscess became much aggravated. Open biopsy and curettage was performed, and metronidazole sensitive Bacteroides fragilis was identified by tissue culture. RESULTS: Metronidazole was administrated for 5 weeks and symptoms were completely resolved. Follow-up magnetic resonance imaging showed that the spondylodiscitis was completely cured. CONCLUSION: This is the first report to be issued regarding BFS secondary to percutaneous epidural adhesiolysis. In our case, the pathogenesis may have been direct inoculation of Bacteroides fragilis into the epidural space and disc during percutaneous epidural adhesiolysis because the procedural approach used was adjacent to the anus.

Efficacy and safety of netilmycin/dexamethasone preservative-free and tobramycin/dexamethasone-preserved fixed combination in patients after cataract surgery.

PURPOSE: To compare the efficacy and safety of preservative-free Netilmycin/Dexamethasone with that of preserved Tobramycin/Dexamethasone, postcataract surgery. METHODS: Prospective, randomized, single-blind study on patients submitted to phacoemulsification. During preoperatory visits, at 7 and 21 days conjunctival hyperemia, corneal edema, Tyndall, Shirmer I, corneal and conjunctival lissamine green and fluorescein staining, and intraocular pressure (IOP) were recorded. Postoperative pain (at day 7) and the subjective tolerability (at day 21) were investigated. RESULTS: Eighty patients completed the study and the data collected were analyzed (44 on Netilmycin/Dexamethasone). Regarding the primary efficacy variable, intraocular inflammation, no microbial events were recorded, but aqueous flare was significantly lower with Tobramycin/Dexamethasone at 1 week (P = 0.002). Regarding secondary efficacy variables, conjunctival hyperemia was lower in patients under Tobramycin/Dexamethasone (P < 0.001), but corneal edema and ocular pain were similar. Regarding safety, no significant differences on ocular surface status were recorded. Both formulations were well tolerated, but Tobramycin/Dexamethasone caused an increased IOP at 1 week (P < 0.0001). CONCLUSIONS: Both the studied fixed combinations are safe and effective in controlling postoperative inflammation and preventing postoperative ocular infections. Tobramycin/Dexamethasone has a quicker anti-inflammatory effect but needs IOP monitoring. Further studies on more patients using a sounder scientific design are needed to confirm our findings.

Neonatal sepsis and later development of atopy

Background: The role of infections on the development of atopy is still widely debated. We aimed to evaluate the effects of neonatal severe sepsis and consequent antibiotic treatment on the development of atopy and allergic diseases. Material and methods: A retrospective enrolment at school age of children with a clear history of neonatal sepsis (NS) was performed from registers of neonatal intensive care units. A normal control was assigned to each patient with sepsis. Thirty six cases with sepsis (18 males, 18 females) and 36 controls (21 males, 15 females) were selected (8.5±3.6 yrs). Physical examination and lung function evaluation were performed. Atopic status was verified by blood eosinophil count, total IgE serum level and skin prick tests (SPT). Results: SPT positivity for at least one allergen was present in 30% of subjects in both groups. No difference for all investigated parameters between groups and no influence by other factors such as familiarity or gender was observed. No correlation was associated to NS history. Conclusions: Neonatal sepsis, even if clinically severe and dramatic, could represent an event too limited and really precocious in life to influence the development of immune response. Furthermore, other factors, besides infections, may influence the atopic future of newborns (AU)

Recurrent and relapsing peritonitis: causative organisms and response to treatment.

BACKGROUND: The clinical behavior and optimal treatment of relapsing and recurrent peritonitis episodes in patients undergoing long-term peritoneal dialysis are poorly understood. STUDY DESIGN: Retrospective study over 14 years. SETTING & PARTICIPANTS: University dialysis unit; 157 relapsing episodes (same organism or culture-negative episode occurring within 4 weeks of completion of therapy for a prior episode), 125 recurrent episodes (different organism, occurs within 4 weeks of completion of therapy for a prior episode), and 764 control episodes (first peritonitis episode without relapse or recurrence). PREDICTORS: Exit-site infection, empirical antibiotics. OUTCOME MEASURES: Primary response (resolution of abdominal pain, clearing of dialysate, and peritoneal dialysis effluent neutrophil count < 100 cells/mL after 10 days of antibiotic therapy), complete cure (resolution by using antibiotics without relapse/recurrence), catheter removal (for any cause while on antibiotic therapy), and mortality. RESULTS: Compared with the control group, more relapsing episodes were caused by Pseudomonas species (16.6% versus 9.4%) and were culture negative (29.9% versus 16.4%); recurrent infections commonly were caused by Enterococcus species (3.2% versus 1.2%) or other Gram-negative organisms (27.2% versus 11.1%) or had mixed bacterial growth (17.6% versus 12.7%). There were significant differences in primary response, complete cure, and mortality rates among groups (P < 0.001 for all comparisons). Compared with the control and relapsing groups, post hoc analysis showed that the recurrent group had a significantly lower primary response rate (86.4%, 88.5%, and 71.2%, respectively), lower complete cure rate (72.3%, 62.4%, and 42.4%, respectively), and higher mortality rate (7.7%, 7.0%, and 20.8%, respectively). LIMITATIONS: Retrospective analysis. CONCLUSION: Relapsing and recurrent peritonitis episodes are caused by different spectra of bacteria and probably represent 2 distinct clinical entities. Recurrent peritonitis episodes had a worse prognosis than relapsing ones.

Netilmicin in the neonate: pharmacokinetic analysis and influence of parenteral nutrition.

OBJECTIVE: The aim of this study was to investigate the impact of parenteral nutrition on netilmicin pharmacokinetics in critically ill neonates during the first week of life. METHOD: A total of 200 neonates (gestational ages 26.4-41 weeks) treated with netilmicin (4-5 mg/kg in extended dosing intervals) for postnatal sepsis in the first week of life received either fluid therapy or parenteral nutrition. Netilmicin peak and trough serum concentrations were monitored and netilmicin pharmacokinetic parameters were compared with and without parenteral nutrition. RESULTS: There were no statistically significant differences between the pharmacokinetic parameters of netilmicin (volume of distribution, elimination half-life, clearance) in critically ill neonates >32 weeks during the first week of life that received either fluid therapy or parenteral nutrition. For neonates <32 weeks this comparison was not feasible as the majority were parenterally fed. CONCLUSION: Provision of parenteral nutrition (versus fluid therapy) in critically ill neonates >32 weeks did not significantly affect netilmicin pharmacokinetics and therefore does not require modification of recommended netilmicin dosage regimens.

Individualising netilmicin dosing in neonates.

PURPOSE: The aim of this study was develop an optimal dosing regimen for netilmicin in neonates. METHODS: This was a population pharmacokinetic study in 97 neonates aged from 2 to 28 days after the due date who were being treated with netilmicin for suspected sepsis. The model was used to simulate dosing regimens. RESULTS: The principle factors influencing netilmicin clearance (CL) were postmenstrual age (PMA) and current body weight (CWT), and the principal determinant of volume of distribution (V) was CWT. The final covariate model was CL = 0.192 x (CWT/2)(1.35) x (PMA/40)(1.03), V = 1.5 x (CWT/2)(0.3). The optimal dosing was 5 mg/kg ever 36 h, 5 mg/kg every 24 h, 6 mg/kg every 24 h and 7 mg/kg every 24 h for neonates < or =27, 28-30, 31-33 and > or =34 weeks PMA, respectively. CONCLUSION: Individualisation of netilmicin dosing in neonates requires adjustment of dose by body weight, and dosing interval by both PMA and CWT.

Effect of topical netilmicin on the reduction of bacterial flora on the human conjunctiva.

PURPOSE: To investigate the effects of topical netilmicin on human conjunctival bacterial flora. METHODS: Fifty-six patients' eyes with cataract were treated three times a day with netilmicin 1 day before the surgery. The fellow eyes of the patients were not treated. After 1 day of netilmicin application cultures of the inferior palpebral conjunctiva were performed in both eyes. Bacterial evaluation is qualitative. McNemar test was used for statistical analyses. RESULTS: The number of eyes with positive culture for coagulase negative staphylococcus (CNS) in untreated eyes was 43 (76.8%) and in treated eyes it was 5 (8.93%) and the difference was statistically significant (p=0.000). In untreated eyes number of negative cultures with no bacterial growth was 8 (14.3%) and it was 47 (83.9%) in the treated eyes. The difference among groups was statistically significant (p=0.000). Netilmicin is found very effective for CNS as the percentage of positive cultures (n=43) in untreated eyes to positive cultures (n=4) in the treated fellow eye was 90.7%. Likewise, all patients with Staphylococcus aureus positive cultures in untreated eyes (n=5) had negative culture for this microorganism in their treated fellow eyes (100%). CONCLUSIONS: The Endophthalmitis Vitrectomy Study demonstrated that the most common causes of postoperative endophthalmitis are coagulase negative microorganisms, S aureus and Streptococcus species. As netilmicin was found effective to reduce the number of positive cultures for these bacteria, it can be used to lower the incidence of postoperative endophthalmitis before surgery.

Impact of aminoglycoside cycling in six tertiary intensive care units: prospective longitudinal interventional study.

AIM: To determine the effect of aminoglycoside cycling in six tertiary intensive care units (ICU) on the rates of sepsis, aminoglycoside resistance patterns, antibiotic consumption, and costs. METHODS: This was a prospective longitudinal interventional study that measured the effect of change from first-line gentamicin usage (February 2002-February 2003) to amikacin usage (February 2003-February 2004) on the aminoglycoside resistance patterns, number of patients with gram-negative bacteremia, consumption of antibiotics, and the cost of antimicrobial drugs in 6 tertiary care ICUs in Zagreb, Croatia. RESULTS: The change from first-line gentamicin to amikacin usage led to a decrease in the overall gentamicin resistance of gram-negative bacteria (GNB) from 42% to 26% (P<0.001; z-test of proportions) and netilmicin resistance from 33% to 20% (P<0.001), but amikacin resistance did not change significantly (P=0.462), except for Acinetobacter baumanni (P=0.014). Sepsis rate in ICUs was reduced from 3.6% to 2.2% (P<0.001; chi(2) test), with a decline in the number of nosocomial bloodstream infections from 55/100 patient-days to 26/100 patient-days (P=0.001, chi(2) test). Furthermore, amikacin use led to a 16% decrease in the overall antibiotic consumption and 0.1 euro/patient/d cost reduction. CONCLUSION: Exclusive use of amikacin significantly reduced the resistance of GNB isolates to gentamicin and netilmicin, the number of GNB nosocomial bacteremias, and the cost of total antibiotic usage in ICUs.

[Aminoglycoside resistance of enterobacteria isolated from urinary infections in surgical departments]. / Rezistenta la aminoglicozide a enterobacteriilor izolate din infectii urinare în sectii cu profil chirurgical.

The aim of the study was to determine the aminoglycosides resistance of Enterobacteriaceae strains isolated from urocultures. Identification of the germs was performed by the API system (BioMerieux) and susceptibility tests was performed by disk-diffusion test (CLSI standards) and with API strips. For detecting the resistance to aminoglycosides we used gentamicin, tobramycin, netilmicin and amikacin. From 2500 urine samples we isolated 673 microbial strains, from which 531 were Enterobacteriaceae, especially E. coli, 57.62% and Klebsiella pneumoniae pneumoniae, 27.68% strains. We observed natural maintained sensibility to aminoglycosides at 55.17% from all the strains we have studied The high prevalence of aminoglycosides resistance of Enterobacteriaceae strains is explained by prolonged antibiotic therapy of patients with invasive diagnostic and therapeutic procedures. A rational policy in prescribing antibiotics in this department is therefore mandatory.

High resistance prevalence towards ampicillin, co-trimoxazole and ciprofloxacin, among uropathogenic Escherichia coli isolates in Mexico City.

BACKGROUND: The prevalence of antimicrobial resistance among uropathogenic E. coli varies widely worldwide; to guide empirical therapy is necessary to have local, up-to-date susceptibility data. METHODOLOGY: We tested 907 isolates from patients in Mexico City by disk diffusion and further characterized ciprofloxacin, cephalosporin and nitrofurantoin resistant strains. RESULTS: Isolates were mostly resistant to ampicillin (74%), trimethoprim-sulfamethoxazole (60.1%) and ciprofloxacin (32.6%). The most effective drug was netilmicin (5.1% resistant) and the most effective of oral drugs was nitrofurantoin (7.4% resistant). Sixty-percent of ciprofloxacin-resistant strains had minimal inhibitory concentrations of 125 microg/ml or higher, well beyond urinary concentrations at the end of the 12-hour inter-dose period for standard oral regimes. Extended-spectrum beta-lactamases were detected in 6% of strains, most of them from community-acquired infections. All strains resistant to nitrofurantoin carried a 20 Kb plasmid, which when transformed into a susceptible recipient, conferred resistance to nitrofurantoin, ampicillin, sulfonamides, streptomycin, and partially protected against ciprofloxacin. CONCLUSIONS: Drugs considered of choice against uncomplicated urinary tract infections are facing high resistance prevalences and resistance determinants formerly seen only at hospitals are now among community strains. Treatment guidelines from developed countries might not reflect these local trends.

[Generalized tetanus complicating a traditional medicine applied for snakebite]. / Tétanos généralisé compliquant un traitement traditionnel instauré après une morsure de serpent.

In many of Africa's rural areas, snakebite victims often resort to traditional healers for first line treatment. This may be source of infectious complications. We report a case of generalized tetanus which occured after 15 days in a 13-years old boy who had applied a traditional, plant-based concoction on a snake bite. He presented with trismus, generalized contractures and fever extended musculo-aponevrotic necrosis of the right upper limb, without loss of consciousness. The only accompanying biological sign was an increased leukocyte count (11,200/mm3) with a predominance of neutrophils (84%). Platelets count, creatinin and AST/ALT titers and haemostasis were all normal, as was the radiogram of the right hand. The clinical outcome was favourable after 3 weeks hopital care (antibiotic, muscle relaxants, antitetanus serotherapy and local wounds care). This clinical observation shows that traditional care for snake bite wounds can be an entry point for tetanus. Appropriate treatment of snake bites in a hospital setting is of the utmost importance, in addition to vaccination against tetanus, in order to reduce the incidence of tetanus in African countries.