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Analysis of sulfamethoxazole in serum from patients treated with trimethoprim-sulfamethoxazole was performed with the agar diffusion assay which is supposed to measure only unconjugated sulfonamide and with the spectrophotometric method which enables one to measure both unconjugated and conjugated sulfonamide. The two methods gave serum concentrations in the same range when used in patients with intact kidney function. In patients with decreased renal function the chemical method yielded higher values, probably due to accumulation of conjugated sulfamethoxazole. The agar diffusion assay gives an accurate answer if the clinical question concerns the therapeutic effect only. The spectrophotometric analytical method has a broader potential since it may be employed irrespective of the clinical question that motivated the analysis.
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Lung transplant for cystic fibrosis has been considered contraindicated in patients who have Burkholderia Cenocepacia infection. A 24-year-old white woman who had cystic fibrosis presented with respiratory failure caused by B. Cenocepacia pneumonia. She was treated with broad-spectrum antibiotics and a double-lung transplant. The chest cavity and both bronchi were irrigated with 0.5% povidone-iodine solution. For immunosuppression, she received induction therapy with alemtuzumab (15 mg) and methylprednisolone and maintenance therapy with tacrolimus, mycophenolate mofetil, and prednisone (5 mg daily). Postoperative antibiotics included intravenous meropenem for 3 weeks; vancomycin for 10 days; and inhaled ceftazidime, oral trimethoprim-sulfamethoxazole, and doxycycline for several months. Follow-up at 25 months after transplant showed that chest radiographs were clear and lung function was normal. At 6 years after transplant, she was working full time and had no recurrence of infection from B. Cenocepacia. This case suggests that patients who have cystic fibrosis and active B. Cenocepacia pneumonia may be successfully treated with a lung transplant.
We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of Toxoplasma gondii infection.
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Twenty-five published trials of antibacterial therapy for acute otitis media were reviewed according to 13 methodologic standards for the design of clinical trials. Randomized, controlled trials, often with the double-blind technique, have been widely applied to assess efficacy. Bias can be further avoided by prognostic stratification according to known risk factors and by the measurement and analysis of patient compliance with treatment. A less frequently recognized problem is the insensitive trial. Bacteriologic diagnosis of the middle ear exudate before therapy can improve the sensitivity of clinical trials. The eradication of pathogens from the middle ear may be a more sensitive measure of outcome than the reduction of ear effusion. The analysis of type II statistical error should be included in trials that reveal no difference between antibacterial agents. The evaluation of new antibacterial agents for this important health problem requires rigorous research design.
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The mean tissue/serum ratio for linezolid was 0.46 (range, 0.18-0.71). The mean tissue/serum ratio for trimethoprim was 1.2 (range, 0.3-4.5) for both standard and high doses, and 0.23 (range, 0.1-0.46) and 0.36 (range, 0.14-1.28) for standard and high doses of sulfamethoxazole, respectively. Linezolid exhibited inhibitory activity in time-kill assays against strains of S. aureus (0.45 ± 0.5 log10 cfu/mL) and β-haemolytic streptococci (2.2 ± 0.6 log10 cfu/mL), while trimethoprim/sulfamethoxazole exhibited bactericidal (>3 log kill) activity against all of these isolates. These findings were consistent for each sampling time and for high as well as standard doses of trimethoprim/sulfamethoxazole.
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A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics.
Plasmapheresis is a safe intervention in extremely ill TEN patients and may reduce the mortality in this severe disease. Prospective studies are needed to further define its usefulness.
A granulomatous pathological reaction to PCP occurs rarely in patients with malignancy. In these cases the clinical presentation may be atypical and bronchoscopy can be non-diagnostic.
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We investigated the molecular characteristics of multidrug-resistant, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae isolated in community settings and in hospitals in Antananarivo, Madagascar.
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A case of Hemophilus ducreyi infection clinically resembling granuloma inguinale is reported. Culture of the causative organism permitted a definitive diagnosis to be made. Combined treatment with tetracycline and sulphamethizole/trimethoprim rapidly cleared the infection.