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In a prospective randomized, blind trial, three groups of patients undergoing elective colonic surgery were compared for frequency of surgical wound infection, intra-operative wound contamination and other postoperative infections. All patients allotted to the three groups received whole gut irrigation (101 balanced salt solution) by gastric tube on the evening before surgery and were treated as follows. Group A: no antibiotics; Group B: neomycin (1 g/l) + bacitracin (50,000 IU/l) + clindamycin (900 mg/l), contained in the last 31 of irrigation fluid; Group C: mezlocillin (4 g) + oxacillin (2 g) intravenously (iv) at induction of anaesthesia, followed by two identical doses at 8 and 16 h. The rate of postoperative wound infection was highest in A (38 per cent) and much lower in B (3.3 per cent, P less than 0.002) and C (6.9 per cent, P less than 0.004). The difference between B and C was statistically not significant. In A a correlation was established between the degree of wound contamination and the occurrence of wound infection. Intra-operative wound contamination was lowest in B (30 per cent), equal in A (58.1 per cent) and B (55.2 per cent). Other infections were least frequent in group C (four of 29 patients), but were not significantly different to groups B (six of 30) and A (nine of 31). It is concluded that antibiotics together with an effective mechanical preparation considerably reduce the rate of wound infection in colonic surgery.
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Antibiotic-resistant pneumococci, especially penicillin-resistant strains, are being increasingly isolated. Pneumococci with intermediate penicillin-resistance (MIC 0.1-1.0 micrograms/ml) have been reported from many parts of the world over the past two decades, and highly resistant strains (penicillin MICs greater than or equal to 2 micrograms/ml) have also appeared. Infection may be acquired in the hospital or community, and nosocomial outbreaks may occur which require control measures to limit organism spread. Most infections occur in children with diminished host responses. Disease caused by pneumococci with intermediate penicillin-resistance may be treated with high doses of penicillin, but disease caused by highly resistant strains, especially meningitis, may require alternative therapy. Pneumococci resistant to sulfonamides, tetracyclines, erythromycin, lincomycin, clindamycin, chloramphenicol, aminoglycosides and rifampin have also appeared. Strains resistant to all the above-mentioned agents, including all beta-lactam antibiotics tested, have been reported from South Africa and Spain. Alternative therapy for resistant strains may include vancomycin, cefotaxime, cefoperazone, ceftriaxone and imipenem. Pneumococci isolated from sites suggestive of infection, especially blood and cerebrospinal fluid, should be routinely tested for penicillin-susceptibility.
We enrolled 499 patients from June 2005 to April 2007. Wound classes were 1 (73%), 2 (22%), 3 (5%), and 4 (0.2%). Prophylactic antibiotics were administered for 153 (31%). Postoperative length of stay ranged from 0 (77%) to 6 days, with 19 (4%) staying 4 days or more. Screening cultures grew S aureus for 186 procedures (36.6%); of these, 141 were methicillin-resistant S aureus (MRSA) (76% of all staphylococcal cultures or 28% of all procedures). Most MRSA had Staphylococcal Chromosomal Cassette mec type II and resistance to clindamycin-typical for hospital-associated strains. There were 10 (2%) surgical site infections, including 4 methicillin-sensitive S aureus, 1 MRSA, 2 with no growth, and 2 with no cultures.
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In intra-abdominal infections, the activity of antimicrobial agents against Bacteroides fragilis and phenotypically related organisms, and the increasing resistance of these organisms, are of particular importance and concern to surgeons. In vitro data suggest that moxifloxacin is more active than other quinolones against obligately anaerobic organisms, including Bacteroides spp.
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Clindamycin phosphate (CLDMP) is effective against Gram-positive and anaerobic bacteria, and is known to have anti-inflammatory properties.
Methicillin-resistant Staphylococcus aureus (MRSA) presently represents approximately 30% of clinical isolates of S. aureus in the USA. Many strains are additionally resistant to erythromycin, 15- and 16-membered macrolides (e.g. azithromycin, spiramycin), clindamycin, aminoglycosides and/or quinolones. A review of the literature shows that quinupristin/dalfopristin, a semisynthetic derivative of pristinamycin, exhibits good in-vitro activity against methicillin-sensitive S. aureus and MRSA (mean MIC90 0.25-1.0 and 0.5-2.0 mg/L, respectively). Its in-vitro bacteriostatic activity is also unaffected by resistance phenotypes for erythromycin, ciprofloxacin, rifampicin or gentamicin. Among erythromycin-resistant MRSA strains, those with constitutive (macrolide and lincosamide) resistance are only 2-fold less sensitive as strains with inducible (14- and 15-membered macrolide only) resistance (MICs 0.5-1.0 and 0.25-1.0 mg/L, respectively). Quinupristin/dalfopristin is at least as active as vancomycin and more active than ciprofloxacin and erythromycin against MRSA. It generally has a more rapid bactericidal action than vancomycin and oxacillin against many strains of MRSA. The bactericidal activity of quinupristin/dalfopristin may be affected by macrolide resistance phenotype: S. aureus strains susceptible or inducibly resistant to macrolides are killed within 6 h, whereas a number of strains constitutively resistant to macrolides remain viable after 12 h. The clinical significance of this laboratory phenomenon requires investigation, possibly in additional animal models of infection.
217 isolates were obtained. All of the 191 isolates that were ICR positive were D-test positive. Of the 27 ICR negative isolates, 10 (37%) were D-test positive [9 methicillin-sensitive S. aureus (MSSA), 1 methicillin-resistant S. aureus (MRSA)]. This correlates with a specificity of 100%, sensitivity of 95%, positive predictive value of 100%, and negative predictive value of 72%.
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Concentrations of antibiotics below the MIC are able to modulate the expression of virulence-associated genes. In this study, the influence of subinhibitory doses of 31 antibiotics on the expression of the gene encoding the staphylococcal alpha-toxin (hla), a major virulence factor of Staphylococcus aureus, was investigated with a novel gene fusion protocol. The most striking observation was a strong induction of hla expression by subinhibitory concentrations of beta-lactams and an almost complete inhibition of alpha-toxin expression by clindamycin. Whereas glycopeptide antibiotics had no effect, the macrolide erythromycin and several aminoglycosides reduced and fluoroquinolones slightly stimulated hla expression. Furthermore, Northern blot analysis of hla mRNA and Western blot (immunoblot) analysis of culture supernatants of both methicillin-sensitive and methicillin-resistant S. aureus strains revealed that methicillin-induced alpha-toxin expression is a common phenomenon of alpha-toxin-producing strains. Some methicillin-resistant S. aureus isolates produced up to 30-fold more alpha-toxin in the presence of 10 microg of methicillin per ml than in its absence. The results indicate that the novel gene fusion technique is a useful tool for studying the modulation of virulence gene expression by antibiotics. Moreover, the results suggest that the effects of certain antibiotics on virulence properties may be relevant for the management of S. aureus infections.
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Thirty different sequence types (STs) were identified. The most prevalent clone was ST320 (46 isolates, 51.1%). ST320 was found in Hong Kong, India, Korea, Malaysia, Saudi Arabia and Taiwan. ST320 isolates were mostly multidrug resistant (MDR) and showed significantly higher resistance rates than other STs for cefuroxime, clindamycin, and trimethoprim/sulfamethoxazole.
The MIC levels to daptomycin were not influenced by the increase in the MIC for vancomycin. There was no statistically significant difference for the sensitivity of ciprofloxacin between the two groups of vancomycin. Regardless of vancomycin, there were a clear relationship between the sensitivity of ciprofloxacin with clindamycin and cotrimoxazole.
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The results clearly show that the use of hydrogen peroxide in vagina can eliminate the main symptoms of bacterial vaginosis, and in particular the malodorous leucoxanthorrhea in 89% of cases at 3 months after the end of treatment, a result that is comparable to that obtained using metronidazole or clindamycin as a vaginal cream. Moreover, hydrogen peroxide facilitates the restoration of normal vaginal bacterial flora (represented by H202-producing lactobacillus) in 100% of cases and normal acid pH (pH<4.5) in 98% of cases; it also fosters the disappearance of clue cells from vaginal smears and anaerobic pathogenic flora from vaginal secretions in 100% of cases. The amine test became negative in 97.8% of cases. All results underwent statistical analysis and were found to be statistically significant.
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While this study does not fully answer the histology of desquamative inflammatory vaginitis, it does highlight the need for further study to identify whether there is an idiopathic subset of desquamative inflammatory vaginitis or whether it is erosive lichen planus.