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Anaerobes are not well recognized as a cause of chronic respiratory infections. A 44-year-old man was referred for evaluation of a progressive pulmonary disease of 7-month duration characterized by hemoptysis and fever. For these complaints, based on the radiological picture, he had already received antituberculous therapy without any relief. He was also subjected to bronchial artery embolization prior to referral. Evaluation of the patient led to a diagnosis of chronic anaerobic pneumonitis. Anaerobic culture of the computed tomography-guided transthoracic aspirate grew Fusobacterium and Veillonella species. Within 2 weeks of therapy with oral clindamycin, there was a dramatic relief in hemoptysis. This was accompanied by remarkable radiological clearance. This report underscores the importance of Veillonella species as a potential respiratory pathogen. A high index of suspicion is required to diagnose chronic anaerobic pneumonitis, which can mimic pulmonary tuberculosis, especially in tuberculosis endemic regions.
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We studied the interaction between drugs and the nonionic block copolymers CRL 8131 and CRL 8142 in the treatment of toxoplasmosis in murine models of the disease. Treatment of acute toxoplasmosis with copolymers alone caused slight prolongation of time to death but not survival. In contrast, significant survival occurred when mice were treated with either copolymer combined with doses of sulfadiazine, pyrimethamine, clindamycin, or atovaquone, which did not prevent mortality when used alone. Treatment with CRL 8131 plus sulfadiazine or pyrimethamine resulted in 50 or 40% survival, respectively. Treatment with the same copolymer plus a dose of clindamycin that protected 40% of the mice when used alone resulted in 100% survival. Treatment of toxoplasmic encephalitis with CRL 8131 plus an ineffective dose of atovaquone reduced the inflammation and numbers of Toxoplasma gondii cysts in the brain. Studies to investigate the drug-enhancing activity of CRL 8131 revealed that mice immunized with toxoplasma lysate plus copolymer had lymphocyte proliferation responses to T. gondii antigens significantly higher than those in mice immunized with lysate alone. Challenge of immunized mice with a lethal inoculum of T. gondii resulted in significant survival. Administration of CRL 8131 alone appeared to cause a down-regulation in the production of gamma interferon and up-regulation in the production of interleukin-2. No differences were noted in the production of tumor necrosis factor alpha between mice treated with CRL 8131 and controls.
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To preliminary study of the resistance mechanisms of S. pneumoniae (S. pn) by determining the resistance rates and gene of S. pn isolated from the lower respiratory tract infection infants.
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Bacterial resistance of Streptococcus pneumoniae against erythromycin and clindamycin and resistance phenotypes of erythromycin-resistant Streptococcus pneumoniae were investigated. The MICs of erythromycin and clindamycin against 345 strains of Streptococcus pneumoniae were tested with agar dilution method; the phenotypes of erythromycin-resistant Streptococcus pneumoniae were detected by double-disk test. One hundred and eighty-three and 171 of 345 (53.0% and 49.6%) of isolates had MICs > or =1 microg/ml for erythromycin and for clindamycin. Among erythromycin-resistant Streptococcus pneumoniae, the percentage of cMLS, iMLS and M phenotype was 90.3% (159/176), 5.7% (10/176) and 4.0% (7/176), respectively. The incidence of erythromycin-resistant Streptococcus pneumoniae is very high in Shanghai. The main phenotype is cMLS.
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An agar medium (medium V) was formulated to determine the minimal inhibitory concentrations (MICs) of antimicrobial agents for bacteria encountered in human periodontal pockets. The medium contained (per liter) Trypticase, 15 g; yeast extract, 5 g; sodium chloride, 5 g; glucose, 2 g; sodium pyruvate, 2 g; sodium formate, 1 g; sodium fumarate, 1.5 g; sodium succinate, 0.1 g; Tween 80, 0.25 ml; agar, 15 g; hemin, 5 mg; and menadione, 0.5 mg. The growth of 50 oral strains was compared on this and six other media which included: Wilkins-Chalgren agar, Schaedler agar, Brucella agar, Trypticase-soy blood agar, and Schaedler and Brucella agars supplemented with whole blood. Growth, for most strains, was greatest on medium V. Medium V was also compared with Wilkins-Chalgren agar, using the same oral strains, to determine the MICs of the following antibiotics: penicillin, tetracycline, chloramphenicol, clindamycin, and erythromycin. The MICs of these antibiotics were essentially the same on both media when growth was quantitatively similar.
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We evaluated the bacteriological and clinical efficacy of the combination of ciprofloxacin/clindamycin in severe diabetic foot infections and we tried to elucidate the relationship between the vascular status of the lower limbs and the outcome of these infections. Initial empirical antibiotic therapy with ciprofloxacin (300 mg/12 hrs IV) and clindamycin (600 mg/8 hrs IV) was administered in 84 hospitalized diabetics with severe lower limb infections. This treatment was continued only in cases with primary clinical improvement. The major endpoints of treatment were: cure, improvement and failure. Evaluation of the vascular status of the lower extremities was performed by high resolution imaging coloured ultrasonography, US-Doppler and TcPO2 measurements. Polymicrobial flora was found in 83% of the cases with an average 2.8 species per specimen. Osteomyelitis was detected in 58 % of the patients. After five days of IV administration of ciprofloxacin and clindamycin the response rate was 95.2%. After three weeks of therapy the clinical outcome was: cure 54.8%, improvement 23.8%, and failure 21.4%. The long term follow up (mean duration 16 months) revealed complete healing of the skin lesions in 63 patients (75%). Unfavorable prognostic factors for these infections were: ankle systolic blood pressure <50 mmHg or toe systolic blood pressure < 30 mmHg and TcPO2 < 20 mmHg. The side effects of the combination of ciprofloxacin/clindamycin were mild and there were no cases of pseudomembranous enterocolitis. The combination of ciprofloxacin/clindamycin was found to provide an excellent empirical as well as definitive treatment of severe diabetic foot infections. The evaluation of the vascular status and the severity of ischaemia of the lower limbs has a strong predictive value in the outcome of these infections.
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Both case patients and close human and animal contacts were investigated by their respective state health departments.
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The aim of this work was to study the potential of delivering clindamycin phosphate, as an efficient antibiotic drug, into a more absorbed, elastic ultradeformable form, transfersomes (TRSs). These vesicles showed an enhanced penetration through ex vivo permeation characters. TRSs were prepared using thin-film hydration method. Furthermore, they were evaluated for their entrapment efficiency, size, zeta potential, and morphology. Also, the prepared TRSs were converted into suitable gel formulation using carbopol 934 and were evaluated for their gel characteristics like pH, viscosity, spreadability, homogeneity, skin irritation, in vitro release, stability, and ex vivo permeation studies in rats. TRSs were efficiently formulated in a stable bilayer vesicle structure. Furthermore, clindamycin phosphate showed higher entrapment efficiency within the TRSs reaching about 93.3% ± 0.8 and has a uniform particle size. Moreover, the TRSs surface had a high negative charge which indicated the stability of the produced vesicles and resistance of aggregation. Clindamycin phosphate showed a significantly higher in vitro release (p < 0.05; ANOVA/Tukey) compared with the control carbopol gel. Furthermore, the transfersomal gel showed a significantly higher (p < 0.05; ANOVA/Tukey) cumulative amount of drug permeation and flux than both the transfersomal suspension and the control carbopol gel. In conclusion, the produced results suggest that TRS-loaded clindamycin are promising carriers for enhanced dermal delivery of clindamycin phosphate.
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Community-acquired, methicillin-resistant Staphylococcus aureus (cMRSA), soft tissue infections are becoming increasingly prevalent in the outpatient setting. Few studies have been specifically designed to examine the efficacy of oral antibiotic therapy for these infections. We performed an observational study to determine the effect of alternative, orally administered antibiotics on cMRSA soft tissue infections. Consecutive patients between January 2001 and March 2004 who had skin or soft tissue infections from which cMRSA was isolated and who had never received vancomycin were studied through retrospective and concurrent review. Primary outcome measures were improvement or resolution of infection 5 and 14 days after initiation of treatment with orally administered antibiotics and rates of recurrence within 30 days after completion of treatment. Thirty subjects met the inclusion criteria. Twenty-one subjects received either clindamycin, trimethoprim/sulfamethoxazole, doxycycline/minocycline, or a fluoroquinolone. Five subjects received a beta-lactam antibiotic with abscess drainage, and four subjects underwent abscess drainage alone. Improvement was noted for all subjects at 5 days, complete resolution of infection occurred for all subjects by 14 to 17 days, and in no case did relapse occur within 30 days. cMRSA skin and soft tissue infections can be successfully treated with orally administered antibiotics to which the organism has demonstrable in vitro susceptibility.
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In a minority of cases, erysipelas recurs despite antibiotic prophylaxis. Based on these cases, we first recommend that all efforts are made to (re)confirm the diagnosis of erysipelas and search for the causative microorganism. Based on this information, the right antibiotic with adequate dosing and timing can be selected. The issue of compliance with the prophylactic treatment should be addressed and finally, the clinician should be aware that prophylaxis does not prevent erysipelas in all cases.