Comparison of three doses of amikacin on alternate days with a daily dose of meropenem during the same period for the treatment of urinary tract infection with E. coli: a double-blind clinical trial.

OBJECTIVES: Urinary tract infections (UTIs) are very common infections in humans, and Escherichia coli (E. coli) is the commonest pathogen leading to UTIs. The generation of beta-lactamase enzymes in this bacterium results in its resistance against many antibiotics. This study compares three doses of amikacin on alternate days with a daily dose of meropenem in the same period for the treatment of UTIs with E. coli in a double-blind clinical trial. METHODS: The current double-blind clinical trial compares three doses of amikacin on alternate days with a daily dose of meropenem in the same period for the treatment of UTIs with E. coli. The patients were assigned to two groups: Intervention (receiving a single dose of amikacin once a day at 48-h intervals for a week, three doses) and control (receiving meropenem for 1/TDS for a week). RESULTS: The E. coli infection frequency was 61 (21 cases of non-ESBL and 40 cases of ESBL-positive infections) and the frequency of the other infections was 52 (46%). In the patients with ESBL E. coli infection, ciprofloxacin (21; 70%) showed the highest antibiotic resistance, and nitrofurantoin (33; 91.7%) showed the highest sensitivity. The baseline variables between the control and intervention groups indicated no significant difference (p > 0.05). The frequency of signs and symptoms showed no significant difference between the amikacin and meropenem groups in the first 24 h and the first week. In the second week of follow-up, no clinical signs or symptoms were observed in the two groups. CONCLUSION: The results of this study showed that treatment with amikacin, 1 g q48h, for one week (three doses) has the same result as meropenem, 1 g q8h, for one week (21 doses). The results are the same for the treatment of UTIs with ESBL positive and ESBL negative. Amikacin can be used once every 48 h to treat UTIs, is less expensive and can be administered on an outpatient basis. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (IRCT) with ID number: IRCT20170417033483N2 on the date 2018-02-13.

Food-borne Botulism Caused by Clay Cheese: A Case Report.

INTRODUCTION: Recently, the use of metal and plastic containers instead of clay containers in producing this type of cheese has provided the anaerobic condition for growing the bacterium and producing the botulinum toxin. In this case report was to introduce "clay cheese dug in the ground" as a source of botulinum toxin for the first time. CASE REPORT: A 34-year-old man with dizziness, asthma, and inability to swallow for four days referred to the hospital emergency department. He had diplopia and ptosis for two days. During admission to the emergency, the patient was conscious without fever, but with dysarthria and bilateral ptosis, an impaired gag reflex, slow right papillary reaction to light, a decreased eye movement, and a decreased power of facial muscles and limbs. The patient reported the use of clay cheese in a week before referring to the emergency. Hematological, biochemical, electrocardiogram, magnetic resonance imaging, and chest X-ray assays were normal. According to the Centers for Disease Control and Prevention classification, these symptoms were related to botulism. The evaluation of serum samples, emission, and gastric juice confirmed botulism by type A toxin. CONCLUSION: Considering the clinical results of this case study, clay cheese, which is produced in the west of Iran, can be introduced as a new source of the botulinum toxin.