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The arrival of new cephalosporins faces the clinician with an evergrowing confusion as to the drug of choice. The older agents (cephalexin, cephradine, cefadroxil and cefaclor) and the newer formulations cefatrizine and cefuroxime axetil are intensively used for treatment of mild and moderate infections. The oldest agents have a better pharmacokinetic profile but are less active against Gram-positives and Gram-negatives. Cefaclor, cefatrizine and cefuroxime axetil have improved in vitro activity against H. influenzae and/or against S. aureus and M. catarrhalis. However the mean free serum concentrations after proposed standard daily doses of cefaclor (3 x 250 mg/d), cefatrizine (2 x 500 mg/d) and cefuroxime-axetil (2 x 250 mg/d) are lower than those of the older cephalosporins. In comparison amoxicillin-clavulanate is equally efficacious, has a more reliable pharmacokinetic profile and is less expensive than cefaclor and cefuroxime axetil in a comparable dose (e.g. 3 x 500 mg/d).
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The combinations of cefuroxime and metronidazole, and amoxycillin/clavulanate (Augmentin) are useful as prophylactic drugs during vascular surgery. In this study the pharmacokinetic profiles of different dosing regimens utilizing these drugs during reconstructive vascular procedures are presented. Three groups of patients, undergoing aortobifemoral or femoropopliteal prosthetic surgery, received one of the following regimens: Group I: 1500 mg metronidazole plus 1500 mg cefuroxime at premedication, Group II: 1500 mg metronidazole at premedication plus 1500 mg cefuroxime at the time of induction anaesthesia, followed by 750 mg of cefuroxime 2 h later, Group III: 2000 mg amoxycillin/200 mg clavulanate at time of induction anaesthesia, followed by 1000 mg amoxycillin/200 mg clavulanate, 3 h later. For determination of the antibiotic concentrations, arterial blood samples were obtained at 30-minute intervals during the entire procedure. An additional sample was collected at the time of inguinal graft site anastomosis. Cefuroxime concentrations in these additional samples were 29.3 +/- 11.2 mg/l in group I and 44.7 +/- 15.9 mg/l in group II. Metronidazole concentrations were satisfactorily high in all patients (38.4 +/- 4.5 mg/l). Amoxycillin/clavulanate concentrations were 35.1 +/- 21.5 mg/l and 4.4 +/- 3.7 mg/l respectively. We recommend a multiple dose administration scheme for prophylaxis in high-risk prosthetic vascular surgery, if the procedure takes more than 2-3 h and antimicrobial agents with a rapid elimination time are used. A multiple dosing scheme ensures sufficiently high antibiotic concentrations, exceeding the MIC of staphylococci and enterobacteria approximately twice, at the time of inguinal graft site anastomosis.
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To evaluate the change in nasopharyngeal carriage of S. pneumoniae during antibiotic therapy prescribed for acute otitis media.
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Co-amoxiclav 2000/125 mg twice daily was at least as effective clinically as co-amoxiclav 875/125 mg three times daily in the treatment of CAP. Although few patients in this study had PRSP infection, 3/3 were successfully treated with co-amoxiclav 2000/125 mg.
Amoxicillin became the most frequently prescribed antibiotic for AOM in 2012, complying with the 2011 French guidelines, while the proportion of prescribed broad-spectrum antibiotics decreased. Our study highlights the importance of guidelines to decrease the prescription of broad-spectrum antibiotics, a crucial factor in the prevention of antibiotic resistance.
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Six E. coli isolates exhibiting amoxicillin/clavulanic acid MICs of 4/2 (two strains), 8/4, 16/8, 32/16 and 64/32 mg/L and norfloxacin MICs of < or =0.25 mg/L (three strains), 32, 64 and 256 mg/L were used. Colony counts were determined over 12 h and differences between the bacterial counts of initial inocula and the bacterial counts at each sampling time-point were calculated.
A 9-year-old male Jack Russell Terrier with a history of travel to Thailand was presented with chronic lethargy, weight loss, unilateral anterior uveitis, pancytopenia, hyperglobulinemia, and proteinuria. Numerous trypomastigotes were found on a blood smear, and using molecular methods the parasite was identified as Trypanosoma evansi. After initial response to treatment, the dog experienced a relapse with central neurologic signs 88 days after initial presentation and died. Antibodies to T evansi were detected in both serum and cerebrospinal fluid (CSF) using a card agglutination test (CATT/T evansi), and PCR analysis of CSF for T evansi was positive. Findings at necropsy included marked non-purulent meningoencephalitis. Chronic infection with T evansi in a dog that returned to Germany following international travel highlights the risk associated with introduction of foreign animal diseases to Europe and the possibility of these infections becoming endemic. Detection of chronic infection and curative therapy of trypanosomiasis are challenging, and infection is usually fatal in the dog.
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Therapeutic options for the treatment of accurately diagnosed bacterial vaginosis are reviewed on the basis of current concepts for treatment of bacterial vaginosis. The importance for screening for bacterial vaginosis is pointed out especially before intrauterine procedures and in pregnant women at risk for premature deliveries. Treatment regimens for pregnant women are discussed as well. Emphasis is given to treatment modalities for recurrent bacterial vaginosis.
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The prevalence of infectious complications after routine hysteroscopy.
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We identified cases in the west of Scotland in the period 1991-1997 and performed polymerase chain reaction amplification and oligonucleotide probing on whole blood.