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The mean duration until removal of all drains was 14.1 and 3.5 days, respectively. Anaerobic bacteria were found in all episodes of local abscesses, whereas 19% of the severe episodes were culture negative, and in 13%, only aerobes were identified. A total of 60 anaerobes were isolated from 27 patients (2.2 isolates/positive sample). The dominating species were Prevotella sp. (n = 17), Peptostreptococcus sp. (n = 15) and Propionibacterium sp. (n = 5). Eighty-seven percent of the isolates were susceptible to penicillin. Ninety-seven percent of the anaerobes were susceptible to amoxicillin + clavulanic acid, imipenem + cilastatin, and clindamycin. Eighty-three percent were susceptible to metronidazol. There was a tendency for a higher rate of episodes with penicillin-resistant bacteria in the patients with severe abscesses (14 vs. 31%). No difference in susceptibility regarding amoxicillin + clavulanic acid and clindamycin (7%) was observed.
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Among the studied strains, 37 genetic subtypes were observed. There were nine groups of identical PFGE patterns. Three corresponded to serotype la and six to serotype III. An erythromycin and clindamycin resistant clone was identified in three colonized women and a newborn with sepsis, which were not epidemiologically related. The hylB gene was equally present in cases of neonatal meningitis or colonized pregnant women.
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A 55-year-old Filipina with Grave's disease, diabetes, hypertension, bronchial asthma, Parkinson's disease and a history of adverse drug reaction to penicillin consulted due to high-grade fever and sore throat. Patient was diagnosed with aplastic anaemia secondary to methimazole and was treated with high-dose granulocyte colony stimulating factor, thrombopoietin and mesterolone. Antibiotics used included levofloxacin, clindamycin, amikacin and fluconazole. Due to bleeding and slow recovery of blood parameters, 30 units of platelets and 7 units of packed red blood cells were transfused during her 22-day admission. This case presents a life-threatening adverse drug reaction in a patient with co-morbid conditions that complicate recovery and limit one's therapeutic options.
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In an urban, academic medical center, we compared patients who received medications at discharge (To-Go medications) with patients who received standard care (a prescription at discharge). Emergency department patients were included if they were older than 18 years; had a discharge diagnosis International Classification of Diseases, Ninth Revision, code for urinary tract infection, pyelonephritis, cellulitis, or dental infection; and presented initially between January and December 2010. Candidates had limited health insurance or were discharged when nearby pharmacies were closed. Return visits were included if the condition was related to the initial diagnosis. Wound checks and scheduled revisits were excluded. Medications dispensed were penicillin, clindamycin, sulfamethoxazole-trimethoprim, and nitrofurantoin.
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Antigen detection tests (ADTs) were used by 64% of the pediatricians; 85% used throat cultures. Strategies for diagnosing streptococcal pharyngitis were throat culture alone (38%), consider positive ADTs definitive and use throat culture when ADTs are negative (42%), ADT alone (13%), ADT and throat culture for all patients with pharyngitis (5%), and no tests for GABHS performed (2%). Thirty-one percent usually or always treated with antibiotics before test results were available. Only 29% of these "early treaters" always discontinued antibiotics when tests did not confirm the presence of group A streptococci. The drug of choice for treatment was penicillin (73%); another 26% preferred a derivative of penicillin, particularly amoxicillin. Many pediatricians altered their management when a patient had recurrent streptococcal pharyngitis. Nearly half of the respondents would use a different antibiotic than they used for routine acute streptococcal pharyngitis. They most often changed to erythromycin (25%), cefadroxil (23%), or amoxicillin-clavulanate (20%). Follow-up throat culture was obtained by 51% of pediatricians after treatment of recurrent streptococcal pharyngitis. A patient with chronic carriage of GABHS and symptoms of pharyngitis would be treated with an antibiotic by 84%; most (62%) would use a penicillin. Other choices were cephalosporins (19%), erythromycin (12%), clindamycin (3%), or rifampin plus penicillin (3%). Tonsillectomy was recommended for symptomatic carriers by 31% of respondents. Carriers without symptoms were less likely to be treated with antibiotics (23%) or referred for tonsillectomy (21%).
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Twenty Bacteroides fragilis group species isolated from children with and without diarrhea were analyzed. Antibiotic susceptibility was performed using an agar dilution method; beta-lactamase production was determined using a nitrocefin method, and plasmids were extracted using a commercial Miniprep System. MIC values ranged from 16 to 256 microg/ml for penicillin, 4-128 microg/ml for amoxicillin/clavulanic acid, 0.25-256 microg/ml for clindamycin, and 16-256 microg/ml for penicillin. beta-Lactamase was detected in all isolates. Only five isolates harbored plasmids varying from 7.8 to 1.8 kb. Loss of 6.4- and 3.8-kb plasmids in B. fragilis C68c was related to antibiotic resistance. Low molecular weight plasmids of 2.8-1.8 kb were stable. PCR amplification of cfiA and cepA genes was observed using total DNA, and the cfiA gene was also amplified from the 6.4-kb plasmid.
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Antibiotic susceptibilities of the collection of C. difficile from the University Hospital of Zurich are similar to those reported by others since the 1980. Patients treated with carbapenems and cephalosporins had the highest risk of developing CDI irrespective of the antimicrobial activity of carbapenems.
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Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions.
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The aims of this study were to assess patient satisfaction, drug efficacy, and the social aspects of quality of life after treatment with benzoyl peroxide/clindamycin topical gel in patients who were dissatisfied with their previous acne treatment regimens.
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The activities of selected antimicrobial agents were evaluated for bacteriostatic and bactericidal activities for a large number of clinically obtained strains of Bacteroides fragilis, with special reference to the incubation time of the microbes with the drugs. If the mode of action of a drug is categorized as bactericidal when the ratio of bactericidal concentration/bacteriostatic concentration is low (less than or equal to 4), and as bacteriostatic when high (greater than or equal to 8), during given periods of incubation, then clindamycin, minocycline and chloramphenicol appeared to be bacteriostatic, and cefoxitin, cefmetazole, latamoxef (moxalactam) and metronidazole bactericidal, when the incubation time was brief (6 hours). All these drugs acted bactericidally on most of the test strains, if the time of incubation was prolonged to 24 hours.
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Through the European Network in the Treatment of AIDS, a multicenter trial is being conducted to compare the efficacy and safety of pyrimethamine (50 mg/day) plus clindamycin (2.4 g/day) with the regimen of pyrimethamine (50 mg/day) and sulfadiazine (4.0 g/day) for induction and maintenance treatment of toxoplasmic encephalitis. By 1 September 1990, 281 patients had been randomized to enter the study. Preliminary data show that 77% of the 148 patients evaluated showed a complete response or improvement with minor sequelae during therapy. Twenty percent of the patients deteriorated. This was due to toxoplasmosis in only 10% of the patients. Side-effects were common in all patients regardless of treatment regimen and consisted mainly of rash (52 cases), fever (31 cases), diarrhea (17 cases) and nausea (12 cases). The final analysis should be available by the middle of 1991.
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This study reviewed a series of patients diagnosed with Propionibacterium acnes infection after shoulder arthroplasty in order to describe its clinical presentation, the means of diagnosis, and provide options for treatment.