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Eleven antibiotics were tested against 1,194 Gram negative bacilli isolated from urinary tract infections at the National University Hospital Center at Cotonou. Among the betalactams tested, only cefotaxime remained active against most of the bacteria tested: 90% of the strains of Escherichia coli and 75% of the strains of Enterobacter cloacae were sensitive. Ampicilline, on the other hand, had lost its activity even on strains which are usually the most susceptible. Thirteen percent of the E. coli strains were sensitive. This reduction in antibiotic activity against bacterial strains in Cotonou, which concerned to various degrees the tetracyclines, chloramphenicol, cotrimoxazole, is less pronounced for the amino-sides (gentamicine and netilmicine), and the quinolones of which nalidixique acid was active against 83.9% of the strains of E. coli. The low frequency of isolation of wild type strains (sensitive to betalactams) is probably the consequence of strong selection pressure due to a massive, and uncontrolled use of antibiotics in Cotonou.
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Mixed opportunistic infection with Pneumocystis carinii and Candida prior to cytotoxic therapy in a young male diagnosed as having acute non-lymphoblastic leukaemia resulted in early catastrophe. The role of awareness of this complication and its prompt management is discussed.
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The patients with malignancies showed shorter durations of symptoms before PCP was diagnosed. The levels of serum markers and the oxygenation index did not differ. CT showed diffuse or widespread ground-glass opacity (GGO) in all of the patients evaluated. None of the AIDS patients demonstrated consolidation, whereas half of the patients with malignancy showed consolidation along with GGO. The extent of GGO scored on CT images was significantly greater in the AIDS patients. No correlation was observed between the CT findings and other clinical parameters. All of the AIDS patients recovered from PCP, whereas six patients with malignancies died within a month after the onset of PCP.
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A 13 year old girl presented with auricular chondritis and recurrent episodes of unexplained chest pain, arthritis, bronchitis, conjunctivitis, prolonged steroid resistant alopecia areata, and a history of recurrent tonsillitis. Both the mosaic of autoimmunity and relapsing polychondritis were considered in the differential diagnosis. The patient was successfully treated with co-trimoxazole. The significance of co-trimoxazole, which is an antibiotic and an immunomodulatory drug, in the treatment of autoimmune disease is discussed.
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Hypersensitivity reactions in patients receiving sulfonamide antibiotics have been frequently documented in the literature, but cross-reactivity with sulfonamide non-antibiotics rarely has been reported.
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There is little evidence as to whether or not antimicrobials help treat persistent diarrhoea in young children in low and middle income countries.
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In Finland the usage of trimethoprim (TMP) alone constitutes about 25% of all drug usage for urinary tract infections. Despite this widespread use the proportion of TMP-resistant strains is almost same as it is in countries where only the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) has been used. In general, strains resistant to TMP were seldom found; only in closed wards did the use of trimethoprim result in an increase in the proportion of resistant strains. In the treatment of acute urinary tract infections, TMP alone (dose, 160 mg taken twice daily for seven days) gave a result as good as that of TMP-SMZ (94.5% vs. 90.6%) and a better result than cephalexin (98.3% vs. 82.1%). TMP proved suitable as a single agent in the treatment of urinary tract infections in outpatients. In a study of long-term treatment, TMP (dose, 100 mg taken once daily), was more effective than nitrofurantoin, methenamine hippurate, TMP-SMZ, or placebo. Fewer adverse effects were associated with TMP than with the other drugs.
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Patients' baseline demographic and clinical characteristics, as well as characteristics of their VAP, were documented. The primary study outcome was the rate of clinical success in patients with S. maltophilia VAP; a secondary outcome was microbiologic plus clinical success rate in these patients. Standard definitions were employed to determine these outcomes related to VAP treatment. The study population had higher injury severity scores and a higher rate of traumatic brain injury than is typically observed in the study's intensive care unit. The median time to diagnosis of S. maltophilia VAP was 15 days (interquartile range 11-24 days). Stenotrophomonas maltophilia was the sole organism isolated in 34% of patients; the other patients had polymicrobial VAP. Despite inadequate empiric antibiotic therapy being administered to 97% of the patients, the overall clinical success rate was 87%. The microbiologic plus clinical success rate was 82%. The most common treatments for S. maltophilia VAP were trimethoprim-sulfamethoxazole (77 patients received monotherapy, 9 received combination therapy) and ciprofloxacin (6 patients received monotherapy, 8 received combination therapy); all-cause and VAP-related mortality rates were 13% and 7%, respectively.
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Little information exists on risk factors for Pseudomonas aeruginosa infection in persons with HIV. We assessed the incidence and factors associated with P aeruginosa among persons with HIV enrolled in a large observational cohort study in Los Angeles.
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Rhinoscleroma is a chronic granulomatous respiratory tract disease. The initial lesion site is often intra-nasal. Giant tumor presentations are rare. The authors report a case of extensive nasal rhinoscleroma.