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38,151 pregnant women who had newborn infants without any congenital abnormalities (control group) and 22,865 case pregnant women who had newborns or fetuses with congenital abnormalities.
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The estimated compliance was correct and stable. The association with a history of tuberculosis suggests that a person having already followed prolonged daily treatment would be more readily compliant to other long term treatments.
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The objective of the present work was to assess whether derivative spectrophotometry could be used to circumvent the overlapping spectral bands of the components and hence use it for routine analysis of the drug.
The in vitro antimicrobial activities of aditoprim (AP), a new dihydrofolate reductase (DHFR) inhibitor, trimethoprim (TMP), sulfadimethoxine (SDM), sulfamethoxazole (SMX), and combinations of these drugs against some porcine respiratory tract pathogens were determined by use of an agar dilution method. The minimal inhibitory concentrations (MIC) of these agents were determined twice against Bordetella bronchiseptica (n = 10), Pasteurella multocida (n = 10), and Actinobacillus pleuropneumoniae (n = 20) strains isolated from pigs suffering from atrophic rhinitis or pleuropneumonia. All B bronchiseptica strains were resistant to AP and TMP. The MIC50 values of AP and TMP for P multocida were 0.25 and 0.06 microgram/ml, respectively, and for A pleuropneumoniae, 1 and 0.25 microgram/ml, respectively. The MIC50 values of SDM and SMX for B bronchiseptica were 4 and 1 micrograms/ml, respectively; for P multocida, 16 and 8 micrograms/ml, respectively; and for A pleuropneumoniae, 16 and 8 micrograms/ml, respectively. The investigated combinations of the DHFR inhibitors and the selected sulfonamides had synergism for the A pleuropneumoniae strains; the MIC90 values of the combinations were less than or equal to 0.06 microgram/ml. Potentiation was not observed for the B bronchiseptica and the P multocida isolates. The MIC of the combinations against B bronchiseptica and P multocida corresponded respectively to the concentrations of the sulfonamides and the DHFR inhibitors in the combinations. For A pleuropneumoniae, 2 types of strains were used (25% of serotype 2 and 75% of serotype 9). Type-2 strains had lower susceptibility than type-9 strains to AP and TMP as well as to SDM and SMX (at least a fourfold difference in MIC between the 2 types of strains).(ABSTRACT TRUNCATED AT 250 WORDS)
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Urinary tract infection (UTI), a major cause of morbidity in renal transplant recipients, has also been found to increase mortality. The first month post-kidney transplantation is considered the critical time, with most UTI episodes during this period. The aim of this study was to compare the efficacy of various doses of trimethoprim-sulfamethoxazole (TMP/SXT) for the prophylaxis of the posttransplant UTI within the first month after kidney transplantation. In a prospective, double-blind, randomized, clinical trial, 95 kidney allograft recipients were divided into two groups: group 1 (n = 63) received low to moderate doses of TMP/SXT (either 80/400 mg or 160/800 mg, daily) and group 2 (n = 32), high doses of TMP/SXT (320/1600 mg, daily in two divided doses). These groups were comparable regarding age, gender, type of donor, and ureteral anastomosis and immunosuppressive therapy. UTI was defined as a urine culture containing more than 10(5) colonies. The mean age of the patients was 37 +/- 12.2 years with a male/female ratio of 0.98/1. The urine culture was positive in 39 patients (41.1%). UTI was more common among female than male patients (P = .003). Escherichia coli was the most common isolated organism in both groups (53.8%). UTI was observed in about 25% of patients on the high-dose versus 49.2% of those on low- to moderate-dose prophylaxis (P < .05). In conclusion, prophylaxis with high-dose TMP/SXT (320/1600 mg, daily) is preferred for renal transplant recipients during the first month posttransplantation.
Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.
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A 61 year old RGP lens wearer with a history of nonresponsive keratitis of the right eye which involved the graft margin was referred to us for treatment. Corneal cultures revealed growth of a gram-negative rod on the fifth day and the organism was subsequently identified as Alcaligenes xylosoxidans, which was resistant to most antibiotics and sensitive only to Bactrim, Timentin, and imipenem.
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134 Gambian children under 5 years of age with severe pneumonia (as defined by the World Health Organisation classification of acute respiratory infections) were given either oral co-trimoxazole for 5 days, or a single intramuscular dose of fortified procaine penicillin and 5 days of oral ampicillin. At 2 weeks, there was no significant difference in outcome between the two groups. Co-trimoxazole is much less expensive than ampicillin or procaine penicillin, requires only twice-daily administration, and can be given by health-care staff with little training. The results support the use of co-trimoxazole as the antibiotic of first choice in outpatient management of young children with pneumonia in developing countries.
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We investigated the mechanism of drug-induced transient myopia, anterior chamber shallowing, and secondary angle-closure glaucoma in a young woman.
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Accompanying the increased use of biologic and non-biologic antirheumatic agents, patients with RA have been exposed to an increased risk of Pneumocystis jirovecii infection, which causes acute fulminant P. jirovecii pneumonia (PCP). Mortality in this population is higher than in HIV-infected individuals. Several guidelines and recommendations for HIV-infected individuals are available; however, such guidelines for RA patients remain less clear. Between 2006 and 2008 we encountered a clustering event of P. jirovecii infection among RA outpatients. Through our experience with this outbreak and a review of the recent medical literature regarding asymptomatic colonization and its clinical significance, transmission modes of infection and prophylaxis of PCP, we have learned the following lessons: PCP outbreaks among RA patients can occur through person-to-person transmission in outpatient facilities; asymptomatic carriers serve as reservoirs and sources of infection; and short-term prophylaxis for eradication of P. jirovecii is effective in controlling PCP outbreaks among RA outpatients.
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Pretransplant Toxoplasma seroprevalence was 13.4% in donors and 17.8% in recipients. The incidence of Toxoplasma donor-recipient mismatch was 9.5% during the 14-year study period, and only 39.1% of mismatched recipients received TMP/SMX prophylaxis. Only four patients seroconverted, of whom two had received prophylaxis. There were no cases of clinical disease; either primary or reactivation.
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After giving a survey on the situation of antibiotic resistance in the region of Northern Bavaria during 1973/74 and comparing the activity of a sulfamethoxazole (SMZ) trimethoprim (TMP) combination to other commonly used antibiotics and chemotherapeutic agents, the results of tests with the new combination of N1-(4,5-dimethyl-2-oxazolyl)-sulfanilamide) (sulfamoxole) and 2,4-diamino-5-(3,4,5-trimethoxy-benzyl)-pyrimidine (trimethoprim) at a ratio of 5:1 (CN 3123; Nevin, Supristol) are compared to those of tests with TMP/SMZ. This was done by correlating the inhibition zone diameters and, on the other hand, by referring to a great number of sensitivity evaluations in routine diagnostic tests. According to the size of the inhibition zone, CN 3123 showed a somewhat greater activity on Enterococcus (fecal streptococci), Escherichia coli, and Klebsiella aerogenes, whereas the TPM/SMZ combination had apparently a stronger antibacterial effect in vitro against Proteus mirabilis, Staphylococcus aureus, and the Achromobacter-group. Analysis of sensitivity readings from routine diagnosis demonstrated accordance of CN 3123 with TMP/SMZ in 92.6% (first series) and 94.2% (second series), respectively. These results should be considered critically in view of the manifold factors which influence sensitivity tests in the agar diffusion method.
Cardiac transplant recipients are often given prophylactic treatments to prevent opportunistic infections such as Pneumocystis carinii. Toxoplasmosis prophylaxis is commonly prescribed for transplant recipients who have not been exposed to this disease but receive a heart from an exposed donor. We reviewed the collective 28-year experience at two urban transplant programs with 596 patients, and found no cases of toxoplasmosis, but all patients received trimethoprim-sulfamethoxazole to prevent Pneumocystis pneumonia. We conclude that specific anti-toxoplasmosis prophylaxis is unnecessary in heart transplant recipients.
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Among older patients receiving warfarin, cotrimoxazole is associated with a significantly higher risk of UGI tract hemorrhage than other commonly used antibiotics. Whenever possible, clinicians should prescribe alternative antibiotics in patients receiving warfarin.
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A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli in the rectum, urethra, and vagina.
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The clinical characteristics of 20 patients with AIDS complicated by PCP (identified from a cohort of 109 patients with AIDS) treated in our hospital during July 2000 to May 2002 were analyzed.
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An imported case of pneumonia caused by penicillin-resistant Streptococcus pneumoniae occurred in a tourist, shortly after arriving in Barbados. The isolate was of serogroup 6 and exhibited intermediate resistance to penicillin. This was the first isolation of penicillin-resistant S. pneumoniae in Barbados.
Two cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients are reported. In one of the cases, the microorganism was isolated from pleural effusion and ascites. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The last one is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.
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Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency associated with elevated serum IgE levels, eczematous skin, recurrent cutaneous infections, and distinctive musculoskeletal features. We report two cases seen at our institution and review the current literature. Patient 1 was an 18-month-old African American boy with recurrent staphylococcal cold abscesses, pneumonia, and bacteremia. He had severely eczematous skin, ultimately complicated by eczema herpeticum. After treatment of systemic infections with culture-directed antibiotics, a brief course of cyclosporine, 5 mg/kg, improved the dermatitis and allowed transition to long-term therapy with oral trimethoprim-sulfamethoxazole. Patient 2 was a 15-year-old Caucasian boy with long-standing HIES. He has been maintained on a regimen of interferon gamma injections given 3 times weekly and monthly intravenous immunoglobulin since the age of 3 years, prophylactic antibiotics, and low-dose fluconazole. He has occasional episodes of cold abscesses and sinusitis, but has had excellent control since institution of this regimen and has not experienced any adverse effects.
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Increased awareness of acute sinusitis, accurate diagnosis and prompt treatment should reduce costs related to unnecessary investigations, time lost from work and complications due to inappropriate treatment. As well, physicians will be better able to decide which patients will not require antimicrobial therapy, thus saving the patient the cost and potential side effects of treatment.
Nocardiosis is an uncommon pediatric infection. We describe the successful treatment of Nocardia brain abscesses and meningitis in an immunocompromized boy with a history of both liver and bone marrow transplants.
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Clinical features of 49 episodes of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome were compared with those of 39 episodes in patients with other immunosuppressive diseases. At presentation patients with the syndrome were found to have a longer median duration of symptoms (28 days versus 5 days, p = 0.0001), lower mean respiratory rate (23.4 versus 30, p = 0.005), and higher median room air arterial oxygen tension (69 mm Hg versus 52 mm Hg, p = 0.0002). The survival rate from 1979 to 1983 was similar for the two groups (57% and 50% respectively). Patients with the syndrome had a higher incidence of adverse reactions to trimethoprim-sulfamethoxazole (22 of 34 versus 2 of 17, p = 0.0007). Survivors with the syndrome at initial presentation had a significantly lower respiratory rate, and higher room air arterial oxygen tension, lymphocyte count, and serum albumin level compared to nonsurvivors. Pneumocystis carinii pneumonia presents as a more insidious disease process in patients with the syndrome, and drug therapy in these patients is complicated by frequent adverse reactions.
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To assess the feasibility and effectiveness of voluntary counselling, HIV testing and adjunctive cotrimoxazole in reducing mortality in a cohort of tuberculosis (TB) patients registered under routine programme conditions in a rural district of Malawi.
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The disease characteristics, management, and outcome of Stenotrophomonas maltophilia endocarditis were evaluated by examining the reports on the subject identified through a comprehensive literature search. Twenty-three (17 male) cases of S.. maltophilia endocarditis were identified. Mean age was 41 +/- 15 years. All patients presented with fever. Prosthetic valves were involved in 12 (52%) cases. Among native valves, the aortic valve was most frequently involved (50%), followed by the tricuspid valve (36%). Twenty (87%) patients had underlying risk factors for the development of endocarditis, including prior valvular or congenital heart disease surgery (60%), intravenous drug abuse (32%), and infected intravascular lines (18%). The endocarditis was postoperative in 14 patients. Seventeen (74%) patients experienced complications including septic embolism (23%), cardiac abscesses (23%), and congestive heart failure (18%). A combination of two or more antibiotics was used in all cases except one. The frequently used antibiotics were aminoglycosides (59%), trimethoprim-sulfamethoxazole (48%), and penicillins (48%). One half of the patients required cardiac surgery, but the proportion of surgically treated cases was higher among prosthetic valve endocarditis (62%). Mortality was 39% and was equally distributed between patients with prosthetic and native valve endocarditis. The S. maltophilia endocarditis carries high complication and mortality rates. The antibiotic regimen should consist of a combination of multiple antibiotics guided by the sensitivity panel. Early surgery may be considered in patients not responding to antibiotic treatment and in those with prosthetic valve endocarditis.
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We compared the efficacy of orally administered ampicillin, 2 g/d, with that of trimethoprim-sulfamethoxazole, 320 mg/d-1600 mg/d, given for 2 or 6 weeks for outpatient management of acute uncomplicated renal infection in women. Of 98 women participating in the trial, 60 had renal infections with susceptible strains, complied with drug therapy, and completed 6 weeks of follow-up. Before treatment, 39 women had symptoms and signs of acute pyelonephritis; 21 had symptoms of cystitis but positive tests for antibody-coated bacteria. All 60 women had alleviation of symptoms and resolution of bacteriuria after 7 days of therapy. Subsequent recurrences occurred in 12 of 27 women given ampicillin, compared with 4 of 33 given trimethoprim-sulfamethoxazole (p = 0.008). Serotyping showed that most recurrences were reinfections with ampicillin-resistant strains. With each drug, a 2-week regimen of therapy proved as efficacious as a 6-week regimen, but the longer regimen was less well tolerated. We conclude that a 2-week treatment regimen is sufficient to manage acute pyelonephritis in outpatients and that trimethoprim-sulfamethoxazole is preferable to ampicillin therapy.
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Seventy-eight of 100 patients with a very likely drug allergy (P > 0.9) had a positive LTT, which indicates a sensitivity of 78%. If allergies to betalactam-antibiotics were analysed separately, the sensitivity was 74.4%. Fifteen of 102 patients where a classical drug allergy could be excluded (P < 0.1), had nevertheless a positive LTT (specificity thus 85%). The majority of these cases were classified as so-called pseudo-allergic reaction to NSAIDs. Patients with a clear history and clinical findings for a cotrimoxazole-related allergy, all had a positive LTT (6/6), and in patients who reacted to drugs containing proteins, sensitization could be demonstrated as well (i.e. hen's egg lysozyme, 7/7). In 632 of the 923 cases, skin tests were also performed (scratch and/or epicutaneous), for which we found a lower sensitivity than for the LTT (64%), while the specificity was the same (85%).
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A new experimental model of hyperphenylalaninemia was proposed. Combination of p.chlorophenylalanine, strongly inhibitor of phenylalanine hydroxylase, and cotrimoxazole, presumably inhibitor of dihydropteridine reductase, produced a good inhibition of phenylalanine hydroxylation in vivo. Thus phenylalaninemia reached values similar to those found in PKU patients, without administration of excess phenylalanine. Tyrosine concentrations remained near the control values and a phenylketonuria occurred.
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Animal carriage of STEC is decreased by vaccination and improved farm practices. Treatment of STEC diarrhea with antibiotics and toxin-binders did not prevent HUS. Public health interventions are the key to preventing STEC-associated diarrhea and HUS.
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A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days.