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1.
BMC Infect Dis ; 19(1): 1049, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829153

RESUMO

BACKGROUND: Diphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates. METHODS: This descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard. RESULTS: From 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1-14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range, < 0.016 to 2 µg/L) and for erythromycin (MIC range, < 0.016 to > 256 µg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 µg/L, while for both azithromycin and clarithromycin were <  0.016 to > 256 µg/L. CONCLUSION: The susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed.


Assuntos
Antibacterianos/uso terapêutico , Corynebacterium diphtheriae/efeitos dos fármacos , Difteria/tratamento farmacológico , Difteria/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Eritromicina/uso terapêutico , Penicilinas/uso terapêutico , Adolescente , Criança , Pré-Escolar , Corynebacterium diphtheriae/isolamento & purificação , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Testes de Sensibilidade Microbiana
4.
Artigo em Inglês | MEDLINE | ID: mdl-31605592

RESUMO

BACKGROUND: Campylobacter infections are typically self-limited, but in cases with severe enteritis, immuno-compromised system and bacteremia, an appropriate antimicrobial treatment is demanding. Our study aim was to determine the isolation rate of Campylobacter among patients with acute enteritis in the capital of North Macedonia and its antimicrobial susceptibility. MATERIAL AND METHODS: A total number of 3820 patients clinically diagnosed as acute enteritis, were included in the study. Stool samples were collected and Campylobacter was isolated and identified by classical microbiological methods. Antimicrobial susceptibility of all isolates to Ceftriaxone, Amoxicillin-clavulonic acid, Erythromycin, Ciprofloxacin, Tetracycline and Gentamicin was determined by disc-diffusion technique. Additionally, minimal inhibitory concentrations of all Campylobacter isolates against erythromycin, ciprofloxacin and tetracycline were determined by Epsilon gradient tests. RESULTS: Campylobacter species was isolated in 97 patients. Although the mean isolation rate of Campylobacter spp. during the whole study period was 2.53%, a statistically significant increase was detected in 2016 and 2017, in comparison with the data from previous four years of the study. The isolation rate of Campylobacter spp. didn't reveal statistically significant difference between males and females (p > 0.05). 46.4 % of patients with Campylobacter enteritis were children at the age under 15 years. Forty-three C. jejuni isolates were susceptible to all six antibiotics, but the remaining 44 isolates revealed resistance to at least one antibiotic. C. coli isolates were resistant to 3 antibiotics simultaneously. Two C. coli isolates only, were susceptible to all 6 antibiotics. 40.90% of C. jejuni and 50% of C. coli isolates were resistant to beta-lactams, fluoroquinolones and tetracyclines, simultaneously. CONCLUSION: The increase of the isolation rate of Campylobacter from patients with acute enteritis indicates the need for permanent isolation and identification of Campylobacter from every clinically diagnosed patient, as acute enteritis. Erythromicin is the most effective antibiotic for treatment of Campylobacter enteritis in our patients. The high level of Campylobacter resistance to beta-lactams, fluoroquinolones and tetracyclines requires more rational approach in the treatment of Campylobacter enteritis.


Assuntos
Infecções por Campylobacter/tratamento farmacológico , Campylobacter/isolamento & purificação , Enterite/microbiologia , Testes de Sensibilidade Microbiana/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Campylobacter/efeitos dos fármacos , Campylobacter/crescimento & desenvolvimento , Criança , Pré-Escolar , Ciprofloxacino/farmacologia , Ciprofloxacino/uso terapêutico , Estudos Transversais , Farmacorresistência Bacteriana/fisiologia , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , República da Macedônia do Norte , Tetraciclina/farmacologia , Tetraciclina/uso terapêutico , Adulto Jovem
5.
Curr Opin Crit Care ; 25(4): 349-355, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31247631

RESUMO

PURPOSE OF REVIEW: This review provides an update of recently conducted studies and randomized controlled trials evaluating prokinetic drugs. RECENT FINDINGS: Prokinetic drugs accelerate gastric emptying and, particularly in patients with gastric dysmotility and enteral feed intolerance, their use increases the delivery of enteral nutrition. However, prokinetic drugs have not been shown to improve patient-centered outcomes in trials but benefit is assumed on the basis of observational studies, which report close associations between gastric dysmotility, enteral feed intolerance and poor outcomes, and improvement in surrogate physiological outcomes when prokinetic drugs are administered. SUMMARY: It may not be feasible to establish superiority of a prokinetic drug within a randomized controlled trial with a patient-centered event as the primary outcome. The use of metoclopramide and erythromycin as prokinetic drugs is based on observations from trials measuring surrogate physiological outcomes. Randomized controlled trials of alternative drug regimens and novel prokinetic drugs have recently been completed and results outlined.


Assuntos
Eritromicina/uso terapêutico , Esvaziamento Gástrico/efeitos dos fármacos , Fármacos Gastrointestinais/uso terapêutico , Metoclopramida/uso terapêutico , Nutrição Enteral , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
BMC Infect Dis ; 19(1): 386, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060497

RESUMO

BACKGROUND: Ewingella americana (Ea) is a Gram-negative, lactose-fermenting, oxidase-negative and catalase-positive bacterium that was first described in 1983 as a new genus and species in the family Enterobacteriaceae. It is not known whether Ea is a true pathogen or simply an opportunistic infectious agent, as most of the cases have been described in patients at risk. CASE PRESENTATION: A 4-year-old girl described here was hospitalized due to a productive cough over the previous 3 weeks and a fever > 38 °C associated with tachypnea over the previous 2 days. Her familial and personal medical histories were negative for relevant diseases, including respiratory infections. At admission, she was febrile (axillary temperature 39.2 °C) and had dyspnea with retractions, grunting and nasal flaring. A chest examination revealed fine crackling rales in the left upper field associated with bilateral wheezing. A chest X-ray revealed segmental consolidation of the lingula of the left lung. Laboratory tests revealed leukocytosis (15.,800 white blood cells/mm3 with 50.3% neutrophils), a slight increase in serum C-reactive protein (11.9 mg/L) and normal procalcitonin values (< 0.12 ng/mL). A nasopharyngeal swab culture did not reveal viral or bacterial respiratory pathogens, including atypical bacteria. A blood culture revealed the presence of a Gram-negative, lactose-fermenting rod that was oxidase negative and catalase positive. The isolate was identified by means of the VITEK®2 identification system (bioMérieux, Firenze, Italy) as Ea. This identification was confirmed by sequencing the 16 s ribosomal deoxyribonucleic acid (rDNA). The pathogen was sensitive to aminoglycoside, fluoroquinolones, carbapenems, cefotaxime, and ceftazidime but was intermediate against sulfametoxazole/trimethoprim and resistant to amoxicillin-clavulanic acid, fosfomycin, and oxacillin. The child was immediately treated orally with amoxicillin-clavulanic acid and erythromycin. Based on the results of a blood culture and sensitivity tests, the amoxicillin-clavulanic acid medication was stopped after 3 days. Erythromycin was continued for a total of 10 days, and the child was discharged after 3 days in the hospital. Follow-up visit 1 month later did not reveal any respiratory problems. CONCLUSION: This case shows that Ea infections in healthy subjects are mild even in pediatric age, and the need for antibiotic therapy is debated. Cases occurring in subjects with underlying chronic disease can be significantly more complicated and require appropriate antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia/tratamento farmacológico , Administração Oral , Aminoglicosídeos , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/farmacologia , Cefotaxima , Pré-Escolar , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Feminino , Fluoroquinolonas , Humanos , Itália , Pneumonia/microbiologia , Pneumonia/patologia , Tórax/diagnóstico por imagem
8.
J Chin Med Assoc ; 82(4): 322-327, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946210

RESUMO

BACKGROUND: Long-term, low-dose macrolide treatment has been in recent use to treat chronic rhinosinusitis. In this study, we investigated the effect of long-term, low-dose erythromycin on patients who had persistent rhinosinusitis after functional endoscopic sinus surgery (FESS). METHODS: Patients with persistent rhinosinusitis for 3 months after FESS were recruited and randomly assigned to two groups. Patients in the erythromycin group took erythromycin (250 mg twice a day) for 12 weeks, while those in the intranasal steroid group were administered with mometasone furoate nasal spray for 12 weeks. Both before and after treatment, sino-nasal symptoms were assessed via questionnaires. Patients also received an endoscopic examination, acoustic rhinometry, smell test, and saccharine transit test. A bacterial culture was obtained from the middle meatus. RESULTS: Seventy-two patients completed the study, with 35 in the erythromycin group and 37 in the intranasal steroid group. Endoscopic scores decreased significantly after treatment in both groups. Erythromycin improved the smell threshold and saccharine transit time better than the intranasal steroid. In contrast, the intranasal steroid increased the second minimal cross-sectional area of the nasal cavity at a level greater than erythromycin had. CONCLUSION: Our study showed that long-term, low-dose erythromycin treatment improved the endoscopic score, smell threshold, and saccharine transit time in patients with persistent rhinosinusitis after FESS.


Assuntos
Antibacterianos/uso terapêutico , Endoscopia/métodos , Eritromicina/uso terapêutico , Seios Paranasais/cirurgia , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Furoato de Mometasona/uso terapêutico , Rinite/cirurgia , Sinusite/cirurgia
9.
Infection ; 47(6): 1055-1057, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30953325

RESUMO

We report a rare case of post-traumatic cutaneous diphtheria in a patient referred from a hospital in rural India. The diagnosis of cutaneous diphtheria was confirmed by the isolation of Corynebacterium diphtheriae cultured from the ulcer of the leg, along with Staphylococcus aureus, Streptococcus pyogenes, and Arcanobacterium haemolyticum. The patient was kept on isolation and treated with erythromycin for 14 days without antitoxin. He was discharged when his subsequent cultures turned out to be negative. Chemoprophylaxis was also given to his family members. Such a case highlights the revisiting of vaccination strategies and the role of cutaneous carriers in transmission of this deadly disease.


Assuntos
Antibacterianos/uso terapêutico , Corynebacterium diphtheriae/isolamento & purificação , Difteria/diagnóstico , Eritromicina/uso terapêutico , Dermatopatias/diagnóstico , Adulto , Difteria/classificação , Difteria/microbiologia , Humanos , Índia , Masculino , Dermatopatias/microbiologia , Resultado do Tratamento
10.
Microb Drug Resist ; 25(7): 1080-1086, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31021299

RESUMO

Aims: To determine the prevalence and the antibiotic resistance patterns of Campylobacter jejuni isolated from pediatric diarrhea patients in central Iran. Materials and Methods: Stool specimens (n = 230) were investigated using a modified Gram stain, two specific culture media, and C. jejuni-specific PCR. Antibiotic resistance profiles and relevant resistance genes were determined. Genetic relationships among a selection of the isolates were studied by Fla typing. Results: Out of the 230 diarrhea samples, 48 (20.8%) cases of C. jejuni were identified using modified Gram stain, 45 (19.5%) using the culture media, and 76 (33%) cases were identified using PCR. The highest antibiotic resistance rates were observed in 37 (82.2%) strains against tetracycline, in 32 (71.1%) against ciprofloxacin, and in 31 (68.8%) against erythromycin. Twenty (44.4%) isolates were resistant to ciprofloxacin and erythromycin simultaneously. Genotypic investigations found 36 (97.3%) strains carrying the tet (o) gene, 31 (96.8%) harboring the cmeB gene, 22 (68.7%) strains with the gyrA6 gene, 20 (64.5%) strains containing a 23S rRNA mutation, and 21 (65.6%) strains with the qnrS gene. Fla typing of a random subset of 14 strains revealed 11 different types showing the genomic diversity of the isolates. Strains sharing the same Fla type could be easily distinguished by their resistance gene profile. Conclusions: This is the first study to demonstrate that genetically diverse quinolone-macrolide-resistant C. jejuni is an important cause of gastroenteritis in children from central Iran. Pediatricians should consider these resistance features once the antibiotic prescription is necessary for prevention of possible complications, especially in those under 5 years of age. Of note, most cases of Campylobacter diarrhea are self-limiting and antibiotics should only be prescribed in those cases where severe complications evolve.


Assuntos
Infecções por Campylobacter/microbiologia , Campylobacter jejuni/efeitos dos fármacos , Campylobacter jejuni/isolamento & purificação , Farmacorresistência Bacteriana/genética , Gastroenterite/microbiologia , Macrolídeos/uso terapêutico , Quinolonas/uso terapêutico , Antibacterianos/uso terapêutico , Infecções por Campylobacter/tratamento farmacológico , Campylobacter jejuni/genética , Criança , Pré-Escolar , Ciprofloxacino/uso terapêutico , Estudos Transversais , DNA Bacteriano/genética , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Eritromicina/uso terapêutico , Feminino , Flagelina/genética , Gastroenterite/tratamento farmacológico , Genótipo , Humanos , Lactente , Irã (Geográfico) , Masculino , Testes de Sensibilidade Microbiana/métodos , RNA Ribossômico 23S/genética , Tetraciclina/uso terapêutico
11.
Emerg Microbes Infect ; 8(1): 461-470, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30898080

RESUMO

Macrolides such as erythromycin are the empirical treatment of Bordetella pertussis infections. China has experienced an increase in erythromycin-resistant B. pertussis isolates since they were first reported in 2013. Here, we undertook a genomic study on Chinese B. pertussis isolates from 2012 to 2015 to elucidate the origins and phylogenetic relationships of erythromycin-resistant B. pertussis isolates in China. A total of 167 Chinese B. pertussis isolates were used for antibiotic sensitivity testing and multiple locus variable-number tandem repeat (VNTR) analysis (MLVA). All except four isolates were erythromycin-resistant and of the four erythromycin-sensitive isolates, three were non-ptxP1. MLVA types (MT), MT55, MT104 and MT195 were the predominant types. Fifty of those isolates were used for whole genome sequencing and phylogenetic analysis. Genome sequencing and phylogenetic analysis revealed three independent erythromycin-resistant lineages and all resistant isolates carried a mutation in the 23S rRNA gene. A novel fhaB3 allele was found uniquely in Chinese ptxP1 isolates and these Chinese ptxP1-ptxA1-fhaB3 had a 5-fold higher mutation rate than the global ptxP1-ptxA1 B. pertussis population. Our results suggest that the evolution of Chinese B. pertussis is likely to be driven by selection pressure from both vaccination and antibiotics. The emergence of the new non-vaccine fhaB3 allele in Chinese B. pertussis population may be a result of selection from vaccination, whereas the expansion of ptxP1-fhaB3 lineages was most likely to be the result of selection pressure from antibiotics. Further monitoring of B. pertussis in China is required to better understand the evolution of the pathogen.


Assuntos
Antibacterianos/farmacologia , Bordetella pertussis/classificação , Farmacorresistência Bacteriana , Eritromicina/farmacologia , Variação Genética , Coqueluche/epidemiologia , Coqueluche/microbiologia , Antibacterianos/uso terapêutico , Bordetella pertussis/efeitos dos fármacos , Bordetella pertussis/genética , Bordetella pertussis/isolamento & purificação , China , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Uso de Medicamentos , Eritromicina/uso terapêutico , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Repetições Minissatélites , Epidemiologia Molecular , Tipagem Molecular , Vacina contra Coqueluche/administração & dosagem , Vacina contra Coqueluche/imunologia , Filogenia , Mutação Puntual , RNA Ribossômico 23S/genética , Seleção Genética , Análise de Sequência de DNA , Sequenciamento Completo do Genoma
12.
Cochrane Database Syst Rev ; 3: CD011571, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30835819

RESUMO

BACKGROUND: Psoriasis is a chronic skin disease that affects approximately two per cent of the general population. Plaque psoriasis is the most common form: it usually appears as raised, red patches of inflamed skin, covered with silvery white scales. The patches often occur in a symmetrical pattern. Guttate psoriasis is a particular form of psoriasis with widespread, small erythematosquamous lesions. Streptococcal infection is suspected to be a triggering factor for the onset of guttate psoriasis, and flare-up of chronic plaque psoriasis. The previous Cochrane Review on this topic was published in 2000; it required an update because antistreptococcal treatment continues to be used to treat psoriasis, especially for the acute form of guttate psoriasis. OBJECTIVES: To assess the effects of antistreptococcal interventions for guttate and chronic plaque psoriasis. SEARCH METHODS: We searched Cochrane Skin Specialised Register, Cochrane Register of Studies Online, CENTRAL, MEDLINE, Embase, LILACS, and five trials registers (January 2019). We checked the reference lists of included and excluded studies and searched conference proceedings from the American Academy of Dermatology, Society for Investigative Dermatology, and European Academy of Dermatology and Venereology. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) assessing antistreptococcal interventions (tonsillectomy or systemic antibiotic treatment) in people with clinically diagnosed acute guttate and chronic plaque psoriasis compared with placebo, no intervention, or each other. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Primary outcome measures were: 1) time-to-resolution; achieving clear or almost clear skin (Physician Global Assessment (PGA) 0 or 1 or Psoriasis Area and Severity Index (PASI) 90 or 100); 2) proportion of participants with adverse effects and severe adverse effects. Secondary outcomes were: 1) proportion of participants achieving clear or almost clear skin; 2) proportion of participants achieving PASI 75 or PGA 1 to 2; 3) risk of having at least one relapse at long-term follow-up. Short-term assessment was defined as within eight weeks of the start of treatment; long-term was at least one year after the start of treatment. MAIN RESULTS: We included five trials (162 randomised participants); three were conducted in a hospital dermatology department. One study declared funding by a pharmaceutical company. Participants' ages ranged from 12 to 77 years; only two participants were younger than 15 years. Mean PASI score at baseline varied from 5.7 (i.e. mild) to 23 (i.e. severe) in four studies. Twenty-three of 162 participants had streptococcus-positive throat swab culture. We did not perform a meta-analysis due to heterogeneity of participants' characteristics and interventions.None of the trials measured our efficacy primary outcome, time-to-resolution, or the secondary outcome, risk of having at least one relapse at long-term follow-up.We rated the quality of the results as very low-quality evidence, due to high risk of bias (absence of blinding of participants and caregivers, and high risk of outcome reporting bias) and imprecision (single study data with a low number of events). Hence, we are very uncertain about the results presented.Guttate psoriasisOne three-armed trial (N = 43) assessed penicillin (50,000 international units (IU)/kg/day in three doses) versus erythromycin (250 mg four times per day) versus no treatment (treatment for 14 days, with six-week follow-up from start of treatment). Adverse events and the proportion of participants achieving clear or almost clear skin were not measured.One trial (N = 20) assessed penicillin (1.6 MU (million units) intramuscularly once a day) versus no treatment (six weeks of treatment, with eight-week follow-up from start of treatment). At six-week (short-term) follow-up, no adverse events were observed in either group, and there was no statistically significant difference between the two groups in the proportion of participants with clear or almost clear skin (risk ratio (RR) 2.00, 95% confidence interval (CI) 0.68 to 5.85).One trial (N = 20) assessed rifampicin (300 mg twice daily) versus placebo (14-day treatment duration; six-week follow-up from start of treatment); none of the review outcomes were measured.These trials did not measure the proportion of participants achieving PASI 75 or PGA 1 to 2.Chronic plaque psoriasisOne trial (N = 50) assessed long-term azithromycin treatment (500 mg daily dose) versus vitamin C. Adverse events were reported in the azithromycin group (10 out of 30 had nausea and mild abdominal upset), but not in the vitamin C group. The proportion of participants who achieved clear or almost clear skin was not measured. In the azithromycin group, 18/30 versus 0/20 participants in the vitamin C group reached PASI 75 at the end of 48 weeks of treatment (RR 25.06, 95% CI 1.60 to 393.59).One trial (N = 29) assessed tonsillectomy versus no treatment, with 24-month follow-up after surgery. One participant in the tonsillectomy group had minor bleeding. At eight-week follow-up, 1/15 in the tonsillectomy group, and 0/14 in the no treatment group achieved PASI 90; and 3/15 participants in the tonsillectomy group, and 0/14 in the no treatment group achieved PASI 75 (RR 6.56, 95% CI 0.37 to 116.7). AUTHORS' CONCLUSIONS: We found only five trials (N = 162), which assessed the effects of five comparisons (systemic antibiotic treatment (penicillin, azithromycin) or tonsillectomy). Two comparisons (erythromycin compared to no treatment, and rifampicin compared to placebo) did not measure any of the outcomes of interest. There was very low-quality evidence for the outcomes that were measured, Therefore, we are uncertain of both the efficacy and safety of antistreptococcal interventions for guttate and chronic plaque psoriasis.The included trials were at unclear or high risk of bias and involved only a small number of unrepresentative participants, with limited measurement of our outcomes of interest. The studies did not allow investigation into the influence of Streptococcal infection, and a key intervention (amoxicillin) was not assessed.Further trials assessing the efficacy and tolerance of penicillin V or amoxicillin are needed in children and young adults with guttate psoriasis.


Assuntos
Antibacterianos/uso terapêutico , Psoríase/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Adolescente , Adulto , Idoso , Ácido Ascórbico/uso terapêutico , Azitromicina/uso terapêutico , Criança , Eritromicina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Penicilina V/uso terapêutico , Psoríase/microbiologia , Psoríase/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rifampina/uso terapêutico , Tonsilectomia , Vitaminas/uso terapêutico
14.
JAMA ; 321(4): 394-398, 2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30694327

RESUMO

Importance: In the United States, the rate of gonococcal ophthalmia neonatorum was an estimated 0.4 cases per 100 000 live births per year from 2013 to 2017. Gonococcal ophthalmia neonatorum can cause corneal scarring, ocular perforation, and blindness as early as 24 hours after birth. In the absence of ocular prophylaxis, transmission rates of gonococcal infection from mother to newborn are 30% to 50%. Objective: To reaffirm the US Preventive Services Task Force (USPSTF) 2011 recommendation on ocular prophylaxis for gonococcal ophthalmia neonatorum. Evidence Review: The USPSTF commissioned a reaffirmation evidence update to identify new and substantial evidence sufficient enough to change its prior recommendation. Findings: Using a reaffirmation process, the USPSTF found no new data that would change its previous conclusion that topical ocular prophylaxis is effective in preventing gonococcal ophthalmia neonatorum and related ocular conditions. The USPSTF found no new data that would change its previous conclusion that there is convincing evidence that topical ocular prophylaxis of all newborns is not associated with serious harms. Therefore, the USPSTF reaffirms its previous conclusion that there is convincing evidence that topical ocular prophylaxis for all newborns provides substantial benefit. Conclusions and Recommendation: The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum. (A recommendation).


Assuntos
Antibacterianos/uso terapêutico , Eritromicina/uso terapêutico , Oftalmia Neonatal/prevenção & controle , Administração Tópica , Humanos , Recém-Nascido , Pomadas , Oftalmia Neonatal/epidemiologia , Estados Unidos/epidemiologia
15.
Am J Perinatol ; 36(1): 105-110, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30103220

RESUMO

OBJECTIVE: To quantify the potential cost savings if azithromycin is substituted for erythromycin in women with preterm premature rupture of membranes (PPROM). STUDY DESIGN: Secondary analysis of a multicentered study investigating magnesium sulfate for the prevention of cerebral palsy in premature infants. All patients with PPROM who received antibiotics for prophylaxis were included in the analysis. The number of expected doses each patient would have received was calculated for erythromycin, multidose azithromycin, and single-dose azithromycin regimens accounting for latency from PPROM to delivery. The wholesale acquisition cost was used to calculate the expected cost of each regimen. RESULTS: There were 981 PPROM patients who received a penicillin class antibiotic and erythromycin. Patients would have received 7,528 intravenous doses and 10,194 oral doses of erythromycin at a combined cost of $357,169. In comparison, patients would have received 6,422 and 3,942 doses at a cost of $15,669 and $9,574 for the multidose and single-dose azithromycin regimens respectively, which represents a more than 95% cost reduction for either regimen compared with erythromycin. CONCLUSION: The use of azithromycin substituted for erythromycin in the standard antibiotic regimen of women with PPROM represents a potential for substantial cost reduction.


Assuntos
Azitromicina , Eritromicina , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Adulto , Antibacterianos/economia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/economia , Antibioticoprofilaxia/métodos , Azitromicina/economia , Azitromicina/uso terapêutico , Análise Custo-Benefício , Eritromicina/economia , Eritromicina/uso terapêutico , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez
16.
J Dermatolog Treat ; 30(6): 627-629, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30415588

RESUMO

Background: Studies of Pitted keratolysis (PK) treatment are limited. Objectives: To study cost-effectiveness and to compare the safety of 4% chlorhexidine scrub with 4% erythromycin gel, for PK infections. Materials and methods: This cohort study was conducted on naval rating cadets with a clinical diagnosis of PK at Chumpol Naval Rating School, Thailand in 2016. Participants were randomly treated with either 4% erythromycin gel or 4% chlorhexidine scrub for 4 weeks. The clinical examinations were evaluated at the baseline and at 1 and 2 months after treatment. A decision-tree model was used to evaluate the costs, resource utilization and outcomes as quality-adjusted life-years (QALYs). Results: Of 344 naval rating cadets, 125 (36.3%) were diagnosed with PK. Sixty-four were treated with erythromycin. Approximately 80% of participants had complete resolution Foot odor were significantly improved at 2 months (p < .001) for both groups. No adverse effects were reported. Total cost for 4 weeks' treatment with the erythromycin gel and chlorhexidine scrub was US$77.34, US$51.9, respectively. Chlorhexidine treatment and erythromycin gel had 0.1526 and 0.1425 QALYs, respectively. Conclusions: treatment of PK with either 4% chlorhexidine scrub or 4% erythromycin gel had similar outcomes. However, using chlorhexidine scrub was more cost-effective.


Assuntos
Clorexidina/uso terapêutico , Análise Custo-Benefício , Eritromicina/uso terapêutico , Ceratose/tratamento farmacológico , Clorexidina/efeitos adversos , Clorexidina/farmacocinética , Estudos de Coortes , Esquema de Medicação , Eritromicina/efeitos adversos , Eritromicina/farmacocinética , Géis/química , Meia-Vida , Humanos , Ceratose/economia
17.
Int J Infect Dis ; 79: 162-168, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30528665

RESUMO

OBJECTIVE: To compare the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolates between an old, urban hospital and a new, rural hospital over the same time period. METHODS: The molecular characteristics of 398 MRSA bloodstream isolates collected between 2007 and 2013 from two hospitals in Taiwan were analyzed retrospectively; 202 isolates were from the old hospital and 196 from the new hospital (opened in 2007). RESULTS: The rate of resistance to multiple antibiotics was significantly higher in the old hospital (93%) than in the new hospital (81%) (p<0.001). Genetic community-associated MRSA carrying staphylococcal cassette chromosome (SCC) type IV or V accounted for 58% of all MRSA isolates in the new hospital, significantly higher than the rate in the old hospital (p=0.018). The rate of spa t037-SCCmec III MRSA was significantly lower in the new hospital than in the old hospital (p=0.02). A significant decreasing trend in spa t002-SCCmec II MRSA isolates was observed in the old hospital (p=0.006), while the proportion of spa t037-SCCmec III MRSA decreased significantly in the new hospital (41.7% to 26.1%, p=0.022). CONCLUSIONS: The rate of multiple antibiotic resistance and the molecular characteristics of MRSA differed significantly between the old and new hospitals and changed over time.


Assuntos
Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Vancomicina/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Eritromicina/uso terapêutico , Fluoroquinolonas , Hospitais , Humanos , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Estudos Retrospectivos , Taiwan/epidemiologia , Teicoplanina/uso terapêutico
18.
Int J Infect Dis ; 80: 129-133, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30572022

RESUMO

OBJECTIVE: This study was performed to analyze the serotype distribution of Streptococcus pneumoniae causing invasive pneumococcal disease (IPD) in children aged 5 years and under in Malaysia and to assess the antimicrobial resistance. METHODS: From 2014 to 2017, a total of 245 invasive S. pneumoniae isolates from children ≤5 years of age were received from hospitals all around Malaysia. All isolates were identified and subjected to serotyping and antimicrobial susceptibility testing. RESULTS: Of the 245 isolates, 117 (48.0%) were from children aged <1year, 46 (19.05%) were from children aged 1-2 years, and 82 (33.0%) were from children aged 2-5 years. The most common serotypes were 14 (26.9%), 6B (19.6%), 19A (11.8%), 6A (10.6%), and 19F (6.9%) and vaccine coverage was 88.2% for PCV13, 64.1% for PCV10, and 63.3% for PCV7. Resistance to penicillin was 0.2% for non-meningitis cases and 22.2% for meningitis cases; erythromycin resistance was reported in 42.9%, co-trimoxazole in 35.9%, and tetracycline in 42.9%. CONCLUSIONS: Serotypes 14, 6B, 19A, 6A, and 19F were the most common serotypes isolated from children with IPD in Malaysia during this pre-vaccination era. The lack of reports on the serotype distribution has limited action for the implementation of PCV in the national immunization programme (NIP). The information from this study may benefit future policies for the introduction of PCV in the Malaysian NIP and ultimately may reduce the morbidity and mortality among children in Malaysia.


Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Pré-Escolar , Eritromicina/uso terapêutico , Feminino , Vacina Pneumocócica Conjugada Heptavalente/uso terapêutico , Hospitais , Humanos , Lactente , Malásia/epidemiologia , Masculino , Penicilinas/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Sorogrupo , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Tetraciclina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Vacinação , Cobertura Vacinal
19.
Pak J Pharm Sci ; 32(5(Special)): 2449-2453, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31894033

RESUMO

The research was carried out to observe the effect of erythromycin pleural fixation in treatment of spontaneous pneumothorax. The 160 patients who had been treated for spontaneous pneumothorax were selected as research objects. They were treated with erythromycin pleural fixation. Statistics were made on the intraoperative blood loss, analgesic dosage, thoracic drainage volume and postoperative hospital stay of the patients. In addition, the overall treatment efficiency of the patients was calculated, and VAS score and SF-36 scale were used to observe the pain degree and quality of life of the patients. The overall treatment efficiency was 87.50% (140/160). Intraoperative blood loss was (106.18±19.03) mL, analgesic dosage was (145.90±20.16) mg, chest drainage was (205.27±34.23) mL and postoperative hospital stay was (4.7±1.2) days. The white blood cell count, neutrophil cell count and mononuclear cell count were recorded. The results showed there were no significant differences in these three indexes before and after the treatment, p>0.05. None of the patients had serious adverse reaction problems. Hence the conclusion was drawn that erythromycin pleurodesis can be used to treat spontaneous pneumothorax patients, and achieve good results.


Assuntos
Antibacterianos/uso terapêutico , Eritromicina/uso terapêutico , Pleurodese/métodos , Pneumotórax/terapia , Adulto , Idoso , Antibacterianos/administração & dosagem , Eritromicina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Med Sci Monit ; 24: 8042-8047, 2018 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-30413681

RESUMO

BACKGROUND Ophthalmia neonatorum, or neonatal conjunctivitis, is an acute infection that occurs within the first 28 days of life. This aim of this survey was to evaluate the current methods of preventive treatment for ophthalmia neonatorum in maternity hospitals in Croatia. MATERIAL AND METHODS The annual hospital birth rate in Croatia is approximately 40,000. A clinical survey was undertaken with data collected using questionnaires sent to all 32 maternity hospitals in Croatia. There was a 100% response rate to the questionnaires. RESULTS Preventive treatment for ophthalmia neonatorum was administrated to all newborns in 75% (24/32) of Croatian maternity hospitals. In 45.8% of maternity hospitals, (11/32) these procedures were performed within the first hour after birth. In 54.2% of maternity hospitals (13/32), preventive treatment for ophthalmia neonatorum was administrated to all newborns from one to three hours after birth. The main treatment agent was tobramycin (83.3%). Other topical prophylactic treatments included povidone-iodine (8.3%), erythromycin (4.2%), and silver nitrate (4.2%). In 25% of obstetric units, prophylaxis for ophthalmia neonatorum was not used routinely, but in cases of diagnosed neonatal conjunctivitis, antibiotic treatment with tobramycin was mainly used. CONCLUSIONS A survey of all 32 maternity hospitals in Croatia showed variation in the prevalence of preventive treatment for ophthalmia neonatorum and the methods used. These findings support the need to implement standardized preventive measures that both conform to international clinical guidelines and recognize treatment availability in Croatia, where topical povidone-iodine is currently preferred for the prevention of ophthalmia neonatorum.


Assuntos
Oftalmia Neonatal/tratamento farmacológico , Oftalmia Neonatal/prevenção & controle , Antibacterianos/uso terapêutico , Croácia , Eritromicina/uso terapêutico , Feminino , Gonorreia/microbiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Neisseria gonorrhoeae/isolamento & purificação , Oftalmia Neonatal/microbiologia , Povidona-Iodo/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Nitrato de Prata/uso terapêutico , Inquéritos e Questionários , Tobramicina/uso terapêutico
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