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Metronidazole-based triple therapy is recommended as second-line therapy in Japan, and levofloxacin-based therapy can be an alternative treatment option.
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DX-619 was potent against all MRS tested, suggesting that it would be a promising candidate for the treatment of methicillin-resistant S. aureus infection if sufficient in vivo concentrations were safely attained.
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A 50-year-old woman received two weeks of cefozopran and two weeks of imipenem for streptococcal endocarditis and vertebral osteomyelitis. Subsequently she received four weeks of oral levofloxacin and eight weeks of oral clarithromycin due to persistent elevation of C-reactive protein. Finally, she was admitted to our hospital due to massive hematuria. Abdominal CT showed rupture of an aneurysm in the right kidney and emergent coil embolization was performed. Multiple sets of blood culture grew Streptococcus oralis, and transthoracic echocardiography revealed vegetation at the aortic valve. Retrospective review of the abdominal images revealed the emergence of the aneurysm during the treatment.
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We report a positive outcome of postcataract endophthalmitis caused by Enterobacter cloacae, which has previously resulted in poor outcomes in endophthalmitis. A 67-year-old man underwent uncomplicated cataract surgery. On the morning of postoperative day (POD) #1, he had significant anterior chamber inflammation without pain, hypopyon, or vitritis but then rapidly developed hypopyon and worsening visual acuity. He underwent a tap and inject with vancomycin and ceftazidime and was prescribed topical steroids and antibiotics as well as oral levofloxacin. On POD #3, cultures of the vitreous and aqueous returned positive for E. cloacae. By POD #6, his hypopyon had resolved with improved vitritis, decreased inflammation, and visual acuity of 20/200. Two weeks after surgery, his best-corrected visual acuity was 20/60. Contrary to prior reports, we demonstrate that it is possible to achieve a good outcome in cases of E. cloacae endophthalmitis treated early with appropriate antibiotics and anti-inflammatory agents.
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Statistical analysis indicated that the capsules containing Surelease-coated pellets had a satisfactory sustained-release behavior and a desired pharmacokinetic property.
The minimum inhibitory concentrations (MICs) of 24 antibiotics were determined for 45 Stenotrophomonas maltophilia strains by the microdilution method at 37 and 30 degrees C (after 24 h and 48 h of incubation). The isolates were obtained from mouth swabs and pus of 116 captive snakes whereas the identical strains (based on PFGE) of the same origin were discarded. At 37 degrees C, the isolates showed a low frequency of resistance to levofloxacin (0 and 8.9 % of resistant strains after 24 and 48 h, MICs(50) 0.5 and 1 mg/L, MICs(90) 1 and 2 mg/L) and cotrimoxazole (2.2 % of resistant strains for 24 and 48 h, MICs(50) 4 mg/L for both time periods, MICs(90) 4 and 8). At 30 degrees C, the most effective drugs were also cotrimoxazole (2.2 and 6.7 %, MICs(50) 4 and 8, MICs(90) 8 and 32) and levofloxacin (8.9 and 46.7 %, MICs(50) 1 and 2, MICs(90) 2 and 4). The isolates were either identically or more susceptible to antibiotics than strains acquired from patients hospitalized at Olomouc University Hospital (the same region) with the exception of ciprofloxacin, cefoperazone, cefoperazone/sulbactam and ceftazidime.
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The use of the fluoroquinolones has markedly increased since the introduction of the respiratory fluoroquinolones. Surveillance data and PK-PD studies have raised concerns about suboptimal patient outcomes with the use of fluoroquinolones for some gram-negative infections, particularly BSIs. PK-PD goals and clinical breakpoints may need to be revised for these infections.
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The minimum inhibitory concentrations (MICs) of 330 nonduplicate Helicobacter pylori isolates to nemonoxacin, tigecycline, and eight other antimicrobial agents were determined by using the agar dilution method. Sequencing the quinolone resistance-determining regions (QRDRs) in the gyrA gene of these isolates was also performed. Resistance to clarithromycin showed an increasing trend during the ten-year study period and was highest (38%) in 2005. Tigecycline had potent in vitro activities against all isolates, with an MIC(90) of 0.06 μg/ml. Among the quinolones tested, nemonoxacin (MIC(50) of 0.12 μg/ml and MIC(90) of 0.25 μg/ml) and gemifloxacin had one to two-fold better in vitro activities than ciprofloxacin, levofloxacin, and moxifloxacin. Among the nine isolates (2.7%) with levofloxacin resistance, four (44.4%) were also resistant to metronidazole, three (33.3%) to clarithromycin, and two (22.2%) to amoxicillin. Isolates with levofloxacin resistance exhibited one or two of three amino acid alterations (Ser-70, Asn-87, and Asp-91) involved in QRDRs in the gyrA gene. A double mutation at Ser70Cys and Asn87Ile had a higher level of resistance. The results of this study suggest a potentially useful role of nemonoxacin and tigecycline in the treatment of infections caused by H. pylori. The gyrA mutation at Ser-70 is a novel finding and has an impact on levofloxacin resistance.