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In this case, E. hermanii was the sole isolate recovered from urine specimens of a pyelonephritis patient. The organism was found to be susceptible to piperacillin-tazobactam, ceftazidime, cefazolin, cefixime, aztreonam, gentamicin, tobramycin, imipenem, meropenem and amikacin, and resistant to amoxicillin. Antibiotic treatment was initiated with oral cefixime (400 mg every 24 hours). The symptoms were relieved within 72 hours after therapy. A urine sample was taken seven days after antibiotic therapy. E. hermanii was no longer isolated.
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To report a case of moxifloxacin-associated neutropenia in a cirrhotic patient with cellulitis.
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This study on the intestinal transport of beta-lactam antibiotics was undertaken to investigate the correlation between cellular transport parameters and the bioavailability.
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To compare media used in immunomagnetic separation (IMS) techniques for the isolation of Escherichia coli O157 from food.
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To determine the efficacy and harms of long-term antibiotics to prevent recurrent UTI in children.
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Despite receiving HIV/STI prevention services, bacterial STIs remain prevalent among FSWs suggesting the need for more effective management of STIs. The guidelines for management of STIs need revision in view of the emerging resistance.
The in vitro activities of cefixime, a new third-generation cephalosporin, and of 18 other antimicrobial agents against 18 strains of Helicobacter pylori were determined. The strains of H. pylori were isolated from gastric biopsy specimens and tested for sensitivity to antibiotics by an agar dilution technique under microaerophilic conditions. Among cephalosporins, cefixime had the highest antibacterial activity, with a MIC for 90% of strains (MIC(90)) of 0.125 mg/l. Josamycin and erythromycin, aminoglycosides and the penicillin group tested were comparatively less active (MIC(90) < or = 0.5 mg/l). Ofloxacin (MIC(90) 0.5 mg/l), ciprofloxacin (MIC(90) 0.125 mg/l) and the monobactam aztreonam (MIC(90) 4 mg/l) were also active. All isolates were susceptible to rifampicin (MIC(90) 1 mg/l) and resistent to cephalothin, cefsulodin and pefloxacin.
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In this 31-site multicenter trial, 565 adult patients with urinary tract infections were randomly assigned to receive either a 10-day course of cefixime 400 mg once daily (n = 279) or amoxicillin 250 mg three times daily (n = 286). Although all patients were included in the safety analysis, only 93 (33 percent) cefixime-treated and 99 (35 percent) amoxicillin-treated patients were fully evaluable for the efficacy analysis. One week after therapy, the evaluable patients treated with cefixime demonstrated a 90 percent clinical cure rate and a 92 percent eradication rate of the baseline pathogen. This compared with an 83 percent clinical cure rate and an 84 percent bacterial eradication rate in the amoxicillin-treated group. The most frequently isolated pathogen was Escherichia coli (80 percent) followed by Proteus mirabilis (10 percent). One hundred thirty-seven (49 percent) of the 279 cefixime-treated and 126 (44 percent) of the 286 amoxicillin-treated patients reported at least one adverse experience during the study. Adverse reactions associated with cefixime were similar to those reported for other beta-lactam antibiotics. The most frequent adverse experiences reported by cefixime-treated patients were diarrhea (15 percent) and stool changes (12 percent). Headaches (11 percent) and diarrhea (9 percent) were the most frequently reported adverse reactions by the amoxicillin-treated patients. Eleven cefixime-treated patients (3.9 percent) and 10 amoxicillin-treated patients (3.5 percent) discontinued therapy because of adverse experiences. Results of this study demonstrate that a once-daily regimen of cefixime is as safe and effective as a three-times-daily regimen of amoxicillin in the treatment of acute urinary tract infections. Although the incidence of bowel changes was somewhat higher in the cefixime treatment group, these events usually resolved when therapy was discontinued.
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In BALB/c mice, Salmonella causes severe biochemical, hematological and histopathological alterations by 5(th) day of infection. Ethanolic extract of propolis at a dose of 300 mg/kg body weight of mice when used alone to treat Salmonella infection in mice gave significant results by 30(th) day of treatment. Similarly, when cefixime (4 mg/kg body weight of mice) was used to treat infection in mice, significant results as compared to infected control were observed after 5(th) day. But when propolis and cefixime were used together in different concentrations in combination therapy, evident results were observed after 5 days of treatment. The levels of various liver and kidney function enzymes, blood indices and the histopathology of liver, spleen and kidney were restored to near normal after 5 days of treatment and at much lower doses as compared to the effective dose when used alone.
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To analyze the trend of antimicrobial susceptibility of Neisseria gonorrhoeae isolates over the years, in a tertiary care hospital of North India.
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The capture/enrichment format of an Mab-based sELISA protocol has the potential to provide a suitable screening assay for the specific detection of pathogenic strains from mixed culture samples like faeces.
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Our objective was to evaluate methods for identifying cattle with high concentrations of Escherichia coli O157 in their feces. In two experiments, feces were collected from cattle orally inoculated with nalidixic acid (Nal)-resistant E. coli O157, and direct plating of diluted feces on sorbitol MacConkey agar with cefixime and potassium tellurite (CT-SMAC) containing Nal was considered the gold standard (GS) method. In experiment 1, methods evaluated were preenrichment direct streak, immunomagnetic separation with most probable number (MPN), and postenrichment direct streak with MPN, all using CT-SMAC. The mean concentration of Nal-resistant E. coli O157 in samples (n = 59) by use of the GS was 3.6 log10 CFU/g. The preenrichment streak detected >3.0 log10 CFU/g samples with a 74.4% sensitivity and 68.8% specificity. Postenrichment direct streak-MPN and immunomagnetic separation-MPN concentrations were correlated significantly with GS concentrations (r = 0.53 and r = 0.39, respectively). In experiment 2 (480 samples), pre- and postenrichment direct streaking performed in triplicate and spiral plating on CT-SMAC were evaluated. For preenrichment streaks, sensitivity was 79.7% and specificity was 96.7% for detecting >3.0 log10 CFU/g when the criterion was positive cultures on at least two plates. For spiral plating at that concentration, sensitivity and specificity were 83.9% and 56.3%, respectively. Postenrichment streaking performed relatively poorly. Triplicate preenrichment streaks of 1:10-diluted feces on CT-SMAC may be useful for identifying cattle shedding high concentrations of E. coli O157. Estimates of sensitivity and specificity enable appropriate application of methods and interpretation of results and may enhance applied research, surveillance, and risk assessments.
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Using data from postmarketing surveillance studies of six antibiotics and six antidepressants, conducted using the observational cohort technique of PEM, the number of reports of vaginal candidiasis was determined in women aged > or =16 years, in each of the first 7 weeks following a prescription for one of these drugs. The relative risks for vaginal candidiasis following the use of these antibiotics and for each of the individual antibiotics compared with antidepressants were calculated for each week and for the overall 7-week period. Women treated with antidepressants were the most suitable comparator group from the PEM database, as they were of a similar age range and the studies were conducted at a similar time period to those of the antibiotics. Also, there was no pharmacological plausibility for vaginal candidiasis being associated with antidepressants.
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An international collaborative survey of susceptibility in community-acquired lower respiratory tract infection pathogens collected > 6000 strains from six countries during 1992 and 1993. The four major pathogens were Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus. MICs of 15 antibiotics were determined and sensitivity interpretations applied using breakpoints based on those of the NCCLS. This analysis highlighted some anomalies, notably for beta-lactams against S. pneumoniae and macrolides against H. influenzae, where apparent sensitivity proportions did not accord with the distribution of MICs. Further analyses were undertaken in order to rank the antibiotics in order of potential usefulness for empirical treatment of LRTI: these included in-vitro potency (mode MIC and MIC90) and a pharmacodynamic comparison, using the ratio Cmax (free drug): MIC90. According to study breakpoints, the most active agents overall were, for S. pneumoniae, cefuroxime, clarithromycin, ofloxacin and chloramphenicol; for H. influenzae, azithromycin, amoxycillin/ clavulanate, cefixime, ceftriaxone, quinolones and doxycycline. However, other analyses suggested that the most active agents overall were, for S. pneumoniae, amoxycillin (+/- clavulanate) and ceftriaxone, and, for H. influenzae, quinolones, ceftriaxone, cefixime and amoxycillin/clavulanate. Overall, the antimicrobial agents with the greatest potential usefulness for empirical treatment were amoxycillin/ clavulanate, ceftriaxone, cefuroxime, ofloxacin and co-trimoxazole. The choice of empirical therapy depends upon local epidemiology and clinician choice, but the Project data may be of value in the decision-making process.
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The lack of baseline data on the prevalence of Escherichia coli O157:H7 in retail minced beef in France prompted this survey of industrial minced beef production.
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An ongoing (1994-98) randomized, community-based trial in Uganda's Rakai District is assessing the assumption that intensive sexually transmitted disease (STD) control efforts result in marked declines in HIV/AIDS prevalence. Described, in this article, are the project design and findings of the first-round baseline survey. 56 communities were grouped into 10 clusters designed to encompass social/sexual networks and clusters within blocks were randomly assigned to the intervention or control arm. All consenting permanent residents of the district are visited in their homes at 10-month intervals where they are administered extensive questionnaires, provide urine and vaginal swab samples, and are offered mass treatment regardless of symptoms or laboratory testing (single oral dose STD treatment in the intervention arm and anthelmintics and iron folate in the control arm). Both groups receive identical health education, condom promotion, and serologic counseling services. In the first round of home visits, 5834 intervention and 5784 control arm subjects were enrolled, representing about 90% of eligible adults. The groups were comparable in terms of sociodemographic and behavioral characteristics and baseline rates of HIV and STDs. 16.9% of subjects were HIV-positive, 10.0% had syphilis, 23.8% of women had trichomonas, and 50.9% had bacterial vaginosis. Detailed STD assessment is expected not only to document the relationship between STD control and HIV, but also to identify which STDs confer the greatest population attributable risk for HIV transmission, facilitating targeted control efforts in the future.
The serum bactericidal activity of three oral cephalosporins was studied in 12 volunteers, after administration of single doses of cefuroxime axetil 250 mg, cefixime 200 mg, cefixime 400 mg and cefetamet pivoxil 500 mg. Serum bactericidal activity against clinical isolates of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae was measured by a standardized microdilution method. Cefuroxime axetil demonstrated the best bactericidal activity against Gram-positive organisms and cefixime was the most bactericidal against Gram-negative bacteria.
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A heterologous gene expression system, Xenopus laevis oocytes, was used to prove the intestinal absorption of various beta-lactam antibiotics mediated by an H(+)-dipeptide cotransport system in rat, rabbit and human small intestines. The microinjection of mRNA (messenger RNA) from rat intestine into Xenopus laevis oocytes led to significantly higher uptakes of p.o. active cephalosporins including zwitter-ionic derivatives (cephalexin, cephradine and cefadroxil) and dianionic derivatives (cefixime and ceftibuten) in comparison with oocytes injected with water, whereas the uptake of cefazolin, a parenterally administered derivative, was negligible in both mRNA- and water-injected oocytes. The uptake of cefadroxil was reduced significantly in the presence of dipeptide and various beta-lactam antibiotics, but not in the presence of an amino acid. After sucrose density gradient centrifugation of mRNA, the highest expression of transport activities of both cefadroxil and ceftibuten was observed in the same mRNA fraction with a size of 2.20 to 3.75 kilobases. mRNA-injected oocytes showed a marked pH-dependency in the uptakes of cefadroxil and ceftibuten, whereas water-injected oocytes exhibited only modes uptakes. The most stimulated uptakes of cefadroxil and ceftibuten were observed at an external pH of 5.5 and 5.0, respectively. Furthermore, injection of mRNA isolated from either rat rabbit or human small intestine into oocytes produced significantly higher uptake of cefadroxil and ceftibuten compared with those by oocytes injected with water. Thus, intestinal absorption of p.o. active beta-lactam antibiotics was confirmed to be mediated by an H+ gradient-dependent transport system across the brush-border membrane of rats, rabbits and humans. The carrier-protein for this process is likely a dipeptide transport system.
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Between 1983 and 1990, an international review of 18 clinical trials was conducted to identify a single-dose regimen of ciprofloxacin that will attain at least a 95% efficacy rate for urogenital and extragenital uncomplicated Neisseria gonorrhoeae infections. The trials took place in the US, Argentina, the UK, Finland, Thailand, South Africa, Spain, Belgium, Poland, and the Netherlands. The studies consisted of 1180 patients who received a single-dose of 100-2000 mg ciprofloxacin. 8 studies compared the single-dose ciprofloxacin regimen with ampicillin/probenecid, amoxicillin/probenecid, ceftriaxone, or spectinomycin. 15 studies used, at least, a single-dose of 250 mg ciprofloxacin to treat 815 patients with 910 infected sites. This dose eradicated N. gonorrhoeae from 100% of male urethral, 100% of female cervical, 99% of male and female rectal, and 96% of male and female pharyngeal sites. In all 18 studies, ciprofloxacin was well tolerated. The leading side effects were headache and nausea. The wholesale cost of a single dose of 250 mg ciprofloxacin is lower than that of other antibiotics used to treat uncomplicated gonorrhea ($2.53 vs. $3.36 for 400 mg ofloxacin, $3.84 for 125 mg ceftriaxone, and $5.60 for 400 mg cefixime). Even though WHO and the US Centers for Disease Control recommend a single-dose of 500 mg ciprofloxacin to treat uncomplicated gonorrhea, the findings of the international studies suggest that a single dose of 250 mg ciprofloxacin effectively treats uncomplicated gonorrhea, even extragenital sites of infection.
Retrospective study for a period of 1-year 3 months from January 2013 to March 2014 at a Tertiary Care Hospital.
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Recent reports indicate decreased susceptibility of S. typhi to fluoroquinolones, especially ciprofloxacin. Chloramphenicol has been suggested as first line therapy of enteric fever in many studies. This is a prospective study that describes the trends of antimicrobial susceptibility of S. typhi and S. paratyphi A causing bacteraemia in children and reports therapeutic failure to ciprofloxacin and evaluates the possible use of chloramphenicol, ampicillin, ciprofloxacin and third generation cephalosporins as first line therapy in the treatment of enteric fever in children.
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7432-S (SCH 39720) was the most active beta-lactam tested against the Enterobacteriaceae, inhibiting 92% of strains at less than or equal to 8.0 micrograms/ml compared to 82%, 65% and 39% of strains inhibited by cefixime, cefuroxime and cefaclor, respectively. 7432-S was also very effective against Haemophilus influenzae (MIC90, less than or equal to 0.25 microgram/ml), Branhamella catarrhalis (MIC90, 4.0 micrograms/ml) and Neisseria meningitidis (MIC90, less than or equal to 0.25 microgram/ml). Serogroup B streptococci and the penicillin-resistant pneumococci were generally less susceptible to 7432-S and comparison cephems than Streptococcus pyogenes or penicillin-susceptible S. pneumoniae isolates. Pseudomonas spp., enterococci, Acinetobacter spp. and Staphylococcus spp. were routinely resistant to 7432-S (MIC50s, greater than or equal to 32 micrograms/ml).