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Sixty-three Staphylococcus aureus isolates with a wide distribution in quantitative beta-lactamase production were tested in vitro against amoxycillin and penicillin in combination with clavulanic acid to establish the influence of total amount of beta-lactamase present on the ability of clavulanic acid to protect against beta-lactamase degradation. The beta-lactamase stability of cefuroxime and dicloxacillin was also evaluated. MIC was determined by agar dilution using Mueller-Hinton agar with both a conventional as well as a 100 times higher inoculum. The strains were tested both with and without induction of the beta-lactamase production. Clavulanic acid was highly effective in protecting against beta-lactamase degradation of both penicillin and amoxycillin. Even when using a high inoculum of strains with induced beta-lactamase production, all strains had MICs below the NCCLS breakpoint of 4/2 mg/l for amoxycillin-clavulanic acid. Both cefuroxime and dicloxacillin were highly stable against staphylococcal beta-lactamase degradation. This study encourages further in vivo evaluation of amoxycillin-clavulanic acid for severe staphylococcal infections.
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A reply-paid questionnaire was sent to 2000 New Zealand GPs. The questions relate to management of a three year old child presenting with her first episode of acute otitis media.
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Fifty-one children aged 2-14 years with recurrent tonsillopharyngitis, presenting dysphagia, fever and lymphadenitis, with more than two similar episodes in the last three years and showing a beta-hemolytic group A streptococci in the pharyngeal smear, were studied. They underwent random treatment for ten days with phenoxymethylpenicillin (40-60 mg/kg/day) (n = 28) or amoxicillin-clavulanic acid (20-40 mg/kg/day) (n = 23) taken orally three times a day. Clinical and bacteriological tests were carried out at 10 days and 2, 6 and 12 months post-treatment. The clinical and bacteriological results showed the superiority of the amoxicillin-clavulanic acid treatment both in the short term (disappearance of symptoms) and in the long term (decrease in recurrence). These results support the idea that betalactamases produced by the pharyngeal flora play an important role in the failures of penicillin.
Acute suppurative thyroiditis is an uncommon disease in children. This paper describes the clinical characteristics and management of children with acute suppurative thyroiditis treated during a 15-year period at National Taiwan University Hospital.
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Stratification of patients by disease severity did not reveal a statistically significant difference in overall microbiological profile. Gram-negative organisms and S. aureus were recovered even from patients with less severe clinical presentations. Pneumococcal resistance varied with the agent tested. These findings may have implications for the selection of appropriate antibiotic therapy.
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Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures, controversy still remains regarding the optimal antibiotic regimen.
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The examinations were carried out in 80 children, without nephrolithiasis, aged 10.1 +/- 4.3 years with bronchopneumonia, treated with beta-lactame antibiotics. The children were divided in two groups: I--children treated with oral amoxicillin + clavulanic acid or cefuroxime axetil (n=40), II--children treated with the same antibiotics intravenously (n=40). The Ox concentration in plasma and urine was measured using an enzymatic method with oxalate oxidase, four times. (0)--before treatment, (a)--in third day and (b)--in last day of administration (10 to 14 day), (c)--3 weeks after finishing treatment with antibiotics.
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Mesotherapy is a treatment method devised for controlling pain syndromes or diseases by subcutaneous microinjections given at or around the involved areas at short intervals of time. Different adverse effects have been described due to this modality of treatment. This report describes 3 patients with cutaneous infection caused by Mycobacterium fortuitum after mesotherapy. Three women, aged 24, 27 and 44 years, presented with similar clinical features, consisting of painful nodules located at the points where mesotherapy had been applied. A smear from a skin biopsy revealed the presence of acid-fast bacilli in all 3 cases. The specimen was cultured and eventually identified as M. fortuitum. A multidrug long-term regimen (combinations of 3 drugs from the following: ciprofloxacin, cotrimoxazole, clarithromycin and amoxicillin-clavulanic acid) was needed to achieve resolution of the lesions. After 15, 25 and 26 months of follow-up, no patient relapsed. Mycobacterium fortuitum is a rapidly growing mycobacterium that can lead to cutaneous infection after minor surgical procedures when aseptic measures are not adequate. Multiple drugs for several months are usually needed to treat this disease successfully.
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The authors report the case of a 45-year-old woman admitted for pneumonia who presented anuric acute renal failure after 12 days of intravenous amoxycillin-clavulanate treatment. Acute renal failure resolved rapidly and completely after antibiotic withdrawal. Analysis of the first post-anuric urine specimen showed many crystals. Infrared spectrophotometry revealed that the crystals were composed of trihydrated amoxycillin. The possibility of intrarenal obstruction due to massive drug crystalluria should not be overlooked in the face of abrupt anuria.