MedWorm: Bactrim

  Identification of CTX-M β-lactamases in Escherichia coli from hospitalized patients and residents of long-term care facilities

Abstract: Bacteria harboring CTX-M extended-spectrum β-lactamases (ESBLs) have been identified worldwide, with most reports coming from regions outside North America. We have identified CTX-M enzymes in 31% of ESBL-positive Escherichia coli isolates from our hospital and more than half (53%) of the isolates from associated long-term care facilities. Approximately 3/4 of all CTX-M–bearing isolates were from urine specimens, with a predominance of CTX-M-15. A large proportion of such isolates were nonsusceptible to levofloxacin, trimethoprim/sulfamethoxazole, and all β-lactam antimicrobials with the exception of the carbapenems, requiring carbapenem therapy for acute urinary tract infection or urinary tract-related sepsis. CTX-M β-lactamases have emerged within our location, and detecti...

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  Comparative in vitro activity of tigecycline and other antimicrobial agents against Shigella species from Kuwait and the United Arab of Emirates

In conclusion, Shigella spp. isolated from symptomatic patients in Kuwait and the UAE demonstrated high rates of resistance to the first-line antibiotics but very susceptible to the carbapenems, cephalosporins, fluoroquinolones and tigecycline. Tigecycline holds promise as a potential drug of choice for the therapy of severe shigellosis. (Source: Journal of Infection and Public Health)

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  Chapter 8 - Fungal infections in immunocompromised patients

As complicações pulmonares se constituem na maior causa de morbidade e mortalidade no hospedeiro imunocomprometido, devido à deficiência nos mecanismos básicos de defesa. Independente da causa da imunodepressão, infecções bacterianas, virais e fúngicas são as mais frequentes. Entre as infecções fúngicas, a aspergilose é a mais comum (incidência de 1-9% e mortalidade de 55-92%) nos diferentes tipos de transplantados. Embora a forma pneumônica seja a mais frequente, lesões do sistema nervoso central e sinusite não são raras. O sinal do halo em TC de tórax representa uma área de baixa atenuação em volta do nódulo, revelando edema ou hemorragia. O padrão ouro para o diagnóstico é a identificação do fungo por cultura de escarro, amostras de LBA ou biópsia. Na falta...

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  In vitro susceptibility to antimicrobial agents and ultrastructural characteristics related to swimming motility and drug action in Campylobacterjejuni and C. coli

In this study, we examined in vitro susceptibility to 36 antimicrobial agents of 109 strains of C. jejuni and C. coli isolated from chickens and patients with enteritis or Guillain–Barré syndrome from 1996 to 2009. Among these agents, carbapenems (imipenem, meropenem, panipenem, and biapenem) showed the greatest activity [minimal inhibitory concentration (MIC)90, 0.03–0.125 μg/ml]. This was followed by sitafloxacin (MIC90, 0.25 μg/ml), furazolidone and azithromycin (MIC90, 0.5 μg/ml), gentamicin and clindamycin (MIC90, 1 μg/ml), and clavulanic acid (β-lactamase inhibitor; MIC90, 2 μg/ml). All or most strains were resistant to aztreonam, sulfamethoxazole, and trimethoprim. Marked resistance was also observed for levofloxacin and tetracyclines. Resistan...

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  Does brucellosis in human pregnancy increase abortion risk? Presentation of two cases and review of literature

We present two pregnant women with brucellosis. One of them delivered normally and the other patient had an abortion. We reviewed the literature regarding the clinical course of brucellosis in pregnant women. Brucellosis during pregnancy can be associated with abortion, congenital and neonatal infections and infection of the delivery team. Therefore treatment with a combination of rifampicin and trimethoprim-sulfamethoxazole should be started as soon as it is diagnosed to prevent possible complications. (Source: Journal of Obstetrics and Gynaecology Research)

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  Current therapy of acute uncomplicated cystitis

Acute uncomplicated cystitis (AUC) is one of the most common bacterial urinary tract infections. AUC frequently occurs in young sexually active, as well as postmenopausal, women. According to the guidelines published by the Infectious Diseases Society of America in 1999, the standard antimicrobial regimen for treatment of AUC is 3 days with trimethoprim[ndash]sulfamethoxazole (TMP/SMX); however, today the most popular antibiotics are the fluoroquinolones because of the emergence of uropathogens that are resistant to TMP/SMX. Fluoroquinolone resistance is also increasing worldwide, although the resistance rates have not been as high as those for TMP/SMX. Extended-spectrum [beta]-lactamase (ESBL)-producing strains are another problem because most nosocomial ESBL producers are also resistant ...

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  Nocardia farcinica lung infection in a patient with cystic fibrosis: a case report

Conclusion: Our case report confirms that this organism can be recovered in persons with cystic fibrosis. Its eradication is necessary especially if the patient is to undergo lung transplantation. (Source: BioMed Central)

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  Effect of the synthetic coumarin, ethyl 2-oxo-2H-chromene-3-carboxylate, on activity of Crotalus durissus ruruima sPLA2 as well as on edema and platelet aggregation induced by this factor.

Authors: Fonseca FV, Baldissera L, Camargo EA, Antunes E, Diz-Filho EB, Corrêa AG, Beriam LO, Toyama DO, Cotrim CA, Toyama MH We show that ethyl 2-oxo-2H-chromene-3-carboxylate (EOCC), a synthetic coumarin, irreversibly inhibits phospholipase A(2) (sPLA2) from Crotalus durissus ruruima venom (sPLA2r) with an IC(50) of 3.1 +/- 0.06 nmol. EOCC strongly decreased the Vmax and Km, and it virtually abolished the enzyme activity of sPLA2r as well as sPLA2s from other sources. The edema induced by sPLA2r+EOCC was less than that induced by sPLA2r treated with p-bromophenacyl bromide, which was more efficient at neutralizing the platelet aggregation activity of native sPLA2r. Native sPLA2r induced platelet aggregation of 91.54 +/- 9.3%, and sPLA2r+EOCC induced a platelet aggregation of 18....

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  Chapter 8: Fungal infections in immunocompromised patients

As complicações pulmonares se constituem na maior causa de morbidade e mortalidade no hospedeiro imunocomprometido, devido à deficiência nos mecanismos básicos de defesa. Independente da causa da imunodepressão, infecções bacterianas, virais e fúngicas são as mais frequentes. Entre as infecções fúngicas, a aspergilose é a mais comum (incidência de 1-9% e mortalidade de 55-92%) nos diferentes tipos de transplantados. Embora a forma pneumônica seja a mais frequente, lesões do sistema nervoso central e sinusite não são raras. O sinal do halo em TC de tórax representa uma área de baixa atenuação em volta do nódulo, revelando edema ou hemorragia. O padrão ouro para o diagnóstico é a identificação do fungo por cultura de escarro, amostras de LBA ou biópsia. Na falta...

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  Recent amoxicillin exposure linked to drug-resistant UTIs in children

Source: Pediatrics Area: News According to research published early online in Pediatrics, children exposed to amoxicillin within 60 days of a urinary tract infection (UTI) are at increased risk for ampicillin-resistant microbes.   Researchers evaluated the impact of previous antimicrobial exposure on the development of antimicrobial resistance in 533 children aged 6 months to 6 years with their first UTI in a retrospective cohort study. The researchers examined the relationship between antimicrobial resistance in UTI isolates and exposure to specific antimicrobial agents (amoxicillin, amoxicillin-clavulanate, cefdinir, trimethoprim-sulfamethoxazole, and azithromycin) in the previous 120 days. The following results were reported:   . 8%, 14%, and 21% were exposed to ...

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  Activity of tigecycline against Streptococcus pneumoniae, an important causative pathogen of community-acquired pneumonia (CAP)

This study describes the activity of tigecycline against S. pneumoniae, an important etiologic agent that was recently added by the United States Food and Drug Administration (FDA) to the Tygacil® monograph for the treatment of CAP. (Source: Journal of Infection)

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  Emergence of Fluoroquinolone Resistance in Outpatient Urinary Escherichia Coli Isolates

Johnson et al recently reported in a large area a rapid and impressive increase in fluoroquinolone resistance in Escherichia coli urine isolates after switching from trimethoprim-sulfamethoxazole to levofloxacin for the initial therapy of urinary tract infection (UTI). (Source: The American Journal of Medicine)

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  Emergence of KPC-producing Klebsiella pneumoniae in Italy

Conclusions: This is the second report of KPC-producing isolates in Italy, but the first concerning KPC type 2 gene, and it may have important implications for controlling the transmission of microorganisms resistant to antibiotics. (Source: BioMed Central)

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  Characterization of CEM-101 Activity Against Gram-Positive Organisms.

Authors: Woosley LN, Castanheira M, Jones RN In vitro activity of CEM-101, a new fluoroketolide, was determined against Gram-positive organisms with various macrolide susceptibility profiles. Experiments for determination of MIC and MBC, timed-killing, single-step and multistep mutation rates, erythromycin induction of resistance, post-antibiotic effect (PAE) and drug interactions were performed for CEM-101 and results compared to telithromycin, macrolides and lincosamides. CEM-101 MBC results remained overall lower than those of telithromycin and CEM-101 displayed a two-fold greater potency compared the ketolide. Timed-killing curve testing resulted in CEM-101 having greater bactericidal activity than telithromycin (>/=3 log10 CFU/ml decrease of initial inoculum at 24 hours) for th...

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  Expanded Clinical Presentation of Community-Acquired MRSA Pneumonia.

CONCLUSION: CA-MRSA pneumonia is also not necessarily a post influenza infection. Despite necrotizing features in many, the mortality of CA-MRSA pneumonia in our series is lower than previously reported and patients do not routinely require ICU care. Treatment with antibiotics which inhibit exotoxin production and/or nontoxigenic strains may explain this improved outcome. PMID: 20173050 [PubMed - as supplied by publisher] (Source: Chest)

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  SULFAMETHOXAZOLE, AND TRIMETHOPRIM (Sulfamethoxazole And Trimethoprim) Injection [Teva Parenteral Medicines, Inc]

Updated Date: Feb 18, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Bacteremia complicating gram-negative urinary tract infections: A population-based study

Conclusions: To our knowledge, this is the first population-based study of bacteremic gram-negative UTI. The linear trend of increasing antimicrobial resistance among gram-negative isolates should be considered when empiric therapy is selected. (Source: Journal of Infection)

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  Poly(lactic acid-glycolic acid) nanoparticles markedly improve immunological protection provided by peptide P10 against murine paracoccidioidomycosis

Conclusions and implications: Combination of sulfamethoxazole/trimethoprim with the P10 peptide entrapped within PLGA demonstrated increased therapeutic efficacy against paracoccidioidomycosis. P10 incorporation into PLGA nanoparticles dramatically reduced the peptide amount necessary to elicit a protective effect. (Source: British Journal of Pharmacology)

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  Chapter 6 - Paracoccidioidomycosis

A paracoccidioidomicose é uma micose sistêmica causada pelo fungo dimórfico Paracoccidioides brasiliensis. A doença é restrita à América Latina. É a principal micose sistêmica no Brasil, com maior frequência nas regiões sul, sudeste e centro-oeste. A doença é adquirida através da inalação de propágulos do fungo. Nas áreas endêmicas, a infecção primária ocorre durante a infância e envolve o sistema imunológico. A forma crônica do adulto mais frequente é de disseminação multifocal, com envolvimento dos pulmões, linfonodos, pele e mucosas. Essa forma tem evolução crônica com diagnóstico tardio. Tosse, dispneia e perda de peso associada a lesões cutâneas e das mucosas são evidentes e constituem as queixas principais da doença. A radiografia simples de tóra...

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  High-intensity signals in the basal ganglia from gadolinium-enhanced T1-weighted MRI as an early change in toxoplasma encephalitis in an AIDS patient

Abstract  A 30-year-old Brazilian man hospitalized with AIDS developed a high-grade fever. Neither culture studies nor radiological examinations revealed the cause; small yet highly intense signals in the basal ganglia were detected upon gadolinium (Gd)-enhanced T1-weighted magnetic resonance imaging (MRI) of the head. This finding was equivocal at that time but obviously abnormal for his age. A week later, he developed a movement disorder in his right arm, speech apraxia, and a worsening disturbance of consciousness. Repeated Gd-enhanced T1-weighted MRI demonstrated incredible changes in the brain; enhanced lesions in the basal ganglia deteriorated over time, multiple nodular and ring-enhanced lesions were observed in almost the entire brain. A diagnosis of toxoplasma ence...

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  Uptake of human pharmaceuticals by plants grown under hydroponic conditions.

Authors: Herklotz PA, Gurung P, Vanden Heuvel B, Kinney CA Cabbage (Brassica rapa var. pekinensis) and Wisconsin Fast Plants (Brassica rapa) were chosen for a proof of concept study to determine the potential uptake and accumulation of human pharmaceuticals by plants. These plants were grown hydroponically under high-pressure sodium lamps in one of two groups including a control and test group exposed to pharmaceuticals. The control plants were irrigated with a recirculating Hoagland's nutrient solution while the test plants were irrigated with a Hoagland's nutrient solution fortified with the pharmaceuticals carbamazepine, salbutamol, sulfamethoxazole, and trimethoprim at 232.5mugL(-1). When plants reached maturity, nine entire plants of each species were separated into components suc...

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  A new enterovirulent Escherichia coli serogroup 64474 showing antigenic and genotypic relationships to Shigella boydii 16.

This study analyzed the phenotypic and genotypic characteristics of 23 E. coli strains isolated in different countries from fecal specimens taken from children with diarrhea. Strains were identified using the VITEK system and typed with rabbit sera obtained against 186 somatic and 53 flagellar E. coli antigens and against 45 Shigella somatic antigens. Biochemical analysis of these strains showed a typical E. coli profile with a defined reaction against both E. coli O179 and S. boydii 16 somatic anti-sera. Agglutination for flagellar antigens showed a response against H2 in 7 strains (30 %), H10 in 2 (9 %), H32 in 12 (52 %), and H34 in 2 (9 %) strains, demonstrating 4 serotypes associated with this new somatic antigen 64474. A serum against one of these E. coli strains (64474) was prepared....

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  Aseptic meningitis, hemolytic anemia, hepatitis, and orthostatic hypotension in a patient treated with trimethoprim-sulfamethoxazole.

CONCLUSION: A 37-year-old African- American man with G6PD deficiency developed hemolytic anemia, hepatitis, orthostatic hypotension, and aseptic meningitis simultaneously after using trimethoprim-sulfamethoxazole. PMID: 20065266 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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  Journal Club: Does antibiotic prophylaxis prevent recurrent urinary tract infections?

A recent study demonstrated that long-term, low-dose trimethoprim-sulfamethoxazole (TMP-SMX) was associated with a modest decrease in urinary tract infections (UTIs) in children who had had at least 1 such symptomatic infection in the past. (Source: Modern Medicine Contemporary Pediatrics)

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  Ivermectin is a nonselective inhibitor of mammalian P-type ATPases

Abstract  Ivermectin is a large spectrum antiparasitic drug that is very safe at the doses actually used. However, as it is being studied for new applications that would require higher doses, we should pay attention to its effects at high concentrations. As micromolar concentrations of ivermectin have been reported to inhibit the sarco-endoplasmic reticulum Ca2+-ATPase (SERCA), we decided to investigate its putative inhibitory effect on other two important P-type ATPases, namely the Na+ , K+-ATPase and H+/K+-ATPase. We first extended the data on SERCA, using preparations from rat enriched in SERCA1a (extensor digitorum longus) and 1b (heart) isoforms. Secondly, we tested the effect of ivermectin in two preparations of rat Na+, K+-ATPase in order to appreciate its putative se...

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  Molecular characterisation of Vibrio cholerae O1 strains carrying an SXT/R391-like element from cholera outbreaks in Kenya: 1994-2007

Conclusions: This study demonstrates that the V.cholerae O1 strains carrying an SXT/R391-like element implicated in recent cholera outbreaks in Kenya has not changed significantly between 1994 and 2007 and are clonally related. (Source: BMC Microbiology - Latest articles)

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  Antimicrobial susceptibility of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Enterobacteriaceae isolates to fosfomycin

In conclusion, in this study fosfomycin exhibited good in vitro antimicrobial activity against MDR and XDR Enterobacteriaceae. We suggest further evaluation of the potential clinical utility of fosfomycin against infections caused by these pathogens. (Source: International Journal of Antimicrobial Agents)

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  Synergistic antimicrobial activity of folic acid antagonists and nucleoside analogs.

In conclusion, these data provide evidence that the in vitro antimicrobial activity of SXT in the presence of thymidine can be significantly improved by combination with a nucleoside analog. PMID: 20028816 [PubMed - as supplied by publisher] (Source: Antimicrobial Agents and Chemotherapy)

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  [Clinical Picture] Giant grains of nocardia actinomycetoma

A 27-year-old woman presented to a tertiary centre for mycology in Mexico City, Mexico, with an 11-year history of progressive swelling and deformity of her right foot, and was no longer able to weight-bear. Clinically, there were draining sinuses and giant, white grains with a seropurulent discharge (). A radiograph of her foot showed marked soft tissue enlargement and bony lytic lesions (). Direct microscopy of the grains showed characteristic features of nocardia (). Histopathology of a skin biopsy showed grains together with a granulomatous inflammatory reaction (). Culture confirmed the presence of Nocardia brasiliensis. The patient had previously been treated unsuccessfully with oral penicillin, which is not a recommended treatment for actinomycetomas. Given the incapacitating nature...

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  Acute intoxication with propafenone and trimethoprim-sulfamethoxazole in a case of suicide attempt.

Authors: Ardıç I, Günebakmaz O, Yarlioglues M, Kaya MG A 17-year-old male ingested about 20 tablets of propafenone (total 6,000 mg) and 24 tablets of trimethoprim (total 1,920 mg) - sulfamethoxazole (total 9,600 mg) with suicidal intent. Within one hour, he was brought to a hospital with vomiting, nausea, and loss of consciousness, where he developed cyanosis and mild acidosis, and eventually cardiorespiratory arrest, despite bicarbonate, saline infusion, and inotropic support. Fortunately, he was fully resuscitated and ventilated, and sinus rhythm was restored. He was then transported to our center. On admission, his heart rate was regular with 55 beats/min and blood pressure was 70/45 mmHg. The 12-lead electrocardiogram (ECG) showed sinus bradycardia, extreme widening...

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  Structural analysis of three peptides related to the transmambranic helix VI of AT1 receptor

Conclusions: Strong correlation was found in the results of biochemical, cellular and structural approaches used to compare WT AT1R to mutant types. Random coil structure of the L265D mutant may be a key point to explain those changes observed in biochemical (binding and signal transduction) and proliferation assays (). β-Turn formation is an important step during early protein folding and this secondary simple structure is present in L262D and WT, but not in L265D. Therefore, leucine 265 seems to play a crucial role in determining an entirely functional AT1R. (Source: Neuropeptides)

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  Efficacy of imipenem therapy for Nocardia actinomycetomas refractory to sulfonamides

Conclusions: Sulfonamides are effective for limited disease of relatively short duration. Imipenem monotherapy or in combination with amikacin is well tolerated and demonstrates efficacy in severe disease refractory to sulfonamides. (Source: Journal of the American Academy of Dermatology)

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  Lower risk of urinary tract infection with low-dose trimethoprim/sulfamethoxazole compared to ...

South Denver Nephrology Associates, Denver, CO. (Source: UroToday)

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  Fast determination of the release degree of compound sulfamethoxazole tablets by using circulation release system combined with ultraviolet spectral net analyte signal method.

Authors: Chen ZQ, Lin FF, Ren L, Yin JH, Xie HP Based on ultraviolet spectral net analyte signals, this research has studied the determination of the two effective components, sulfamethoxazole (SMZ) and trimethoprim (TMP), contained in compound sulfamethoxazole tablets in acid environment. The linear ranges of SMZ and TMP were 0.48-7.84 microg/ml (the regression correlation coefficient r = 0.9981) and 0.12-1.5 microg/ml (r = 0.9986), the corresponding average recoveries were 99.5 and 101.0%, respectively, and the relative standard deviations were 1.87 and 3.60%, respectively. The method was simple, fast and accurate. A circulation release system for the determination of the tablet release degree has been built, and the on-line filtering and small-volume sampling could thus be carried o...

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  Herpes: From Mom to Baby—and Back Again, Via Breast-feeding

A 10-month-old breast-feeding boy was taken to the emergency department (ED) with a temperature of 40°C (104°F). Because he was on day 7 of treatment with amoxicillin for a previously diagnosed ear infection, unresolved otitis media was diagnosed. Trimethoprim/sulfamethoxazole (TMP/SMX) was prescribed. (Source: Consultant Live)

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  Prevalence of clinical meticillin-resistant Staphylococcus aureus (MRSA) with high-level mupirocin resistance in Shanghai and Wenzhou, China

Abstract: A total of 803 clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates obtained from Shanghai and Wenzhou in China were subjected to a screening test by disk diffusion for detection of mupirocin resistance. Among the 803 strains, 53 (6.6%) were mupirocin-resistant. Of these 53 strains, all were discovered by the agar dilution method and polymerase chain reaction (PCR) to be high-level mupirocin-resistant and to harbour the mupA gene. Plasmid DNA hybridisation and curing experiments disclosed that mupA was located on a large plasmid varying in size between 23.0kb and 52.4kb in all strains. Susceptibility testing of 10 antibiotics revealed that resistance rates between the Shanghai isolates and the Wenzhou isolates to trimethoprim/sulfamethoxazole and rifampicin differe...

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  Transient detection of E1-containing adenovirus in saliva after the delivery of a first-generation adenoviral vector to human parotid gland

Radiation-induced salivary hypofunction is a common side-effect of treatment for head and neck cancers. Patients suffer significant morbidity and there is no suitable conventional therapy. We are conducting a Phase I clinical trial, using a first-generation serotype 5 adenoviral (Ad5) vector encoding human aquaporin-1 (AdhAQP1) to treat such patients. One week after the administration of AdhAQP1 to an enrolled, generally healthy patient, E1-containing adenovirus was detected in parotid saliva.The real-time quantitative polymerase chain reactuion (PCR) was used to measure the Ad5 E1 gene and AdhAQP1 in saliva and serum. PCR and sequencing were used to characterize viral/vector DNA extracted from saliva. The presence of infectious adenovirus was assessed by the inoculation of A549 cells with...

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  Isolation and molecular characterization of multidrug-resistant Gram-negative bacteria from imported flamingos in Japan

This study highlights the role of animal importation in the dissemination of multidrug-resistant bacteria, integrons and antimicrobial resistance genes from one country to another. (Source: BioMed Central)

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  Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997–2007

Conclusion  Our study reveals that resistance rates have been increasing during the last decade. Published resistance rates may lack information due to important differences regarding age, gender, and probable origin of the isolates. Empirical therapy for UTI should be guided more on individual risk profile and local resistance data than on resistance data banks. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s15010-009-8457-0Authors L. Blaettler, University Hospital Basel Division of Infectious Diseases and Hospital Epidemiology Petersgraben 4 4031 Basel SwitzerlandD. Mertz, University Hospital Basel Division of Infectious Diseases and Hospital Epidemiology Petersgraben 4 4031 Basel SwitzerlandR. Frei, University Hospital Basel Microbiology Laboratory Ba...

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  Iatrogenic, sulfonamide-induced hypothyroid crisis in a Labrador Retriever

This case report describes a sulfonamide-induced hypothyroid crisis in a 4-year-old Labrador Retriever bitch. Empirical therapy with high-dose trimethoprim-sulfamethoxazole for 10 days produced signs of weakness, ataxia and mental depression and the clinicopathological results supported hypothyroid-induced central nervous system depression. Short-term levothyroxine sodium therapy led to complete resolution of all clinical signs and follow-up thyroid hormone assays ruled out underlying thyroid pathology. This case report is the first to highlight this potentially life-threatening manifestation of sulfonamide-induced hypothyroidism. Sulfonamide combinations are widely used antimicrobials in veterinary medicine and early recognition of this syndrome is critical. (Source: Australian Veterinary...

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  Effects of antibiotics on expression and function of Toll-like receptors 2 and 4 on mononuclear cells in patients with advanced cirrhosis

We examined TLR expression and function in cirrhosis, and whether this is affected by antibiotic therapy.Methods: Sixty-four subjects were included (23 controls and 41 Child-Pugh C cirrhotic patients). Thirty patients were taking norfloxacin or trimethoprim-sulfamethoxazole as prophylaxis against bacterial peritonitis and 11 were not. In a second study, 8 patients were examined before and after commencement of antibiotics. Monocyte expression of TLR2 and 4 was determined by flow cytometry. Monocytes from the patients with paired samples were stimulated using TLR ligands and TNF-α production measured.Results: Patients not taking antibiotics had significantly decreased TLR4 expression compared with controls (0.74 vs. 1.0, p=0.009) and patients receiving antibiotics (0.74 vs. 0.98, p=0.02). ...

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  Lower risk of urinary tract infection with low-dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid-withdrawal immunosuppression regimen

Conclusions: For renal transplant recipients over the age of 47 yr, treated without long-term glucocorticoids, our retrospective data suggest that low-dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis. (Source: Clinical Transplantation)

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  Prophylaxis Works ‘Modestly’ for Pediatric UTIs

Long-term, low-dose trimethoprim-sulfamethoxazole “modestly” decreases the number of urinary tract infections in predisposed children, according to a recent report. However, it remains unknown whether this effect translates into preventing kidney damage from pyelonephritis, and “the magnitude of the benefit is likely to be small at best,” said Dr. Jonathan C. Craig of the University of Sydney and his associates (N. Engl. J. Med. 2009;361:1804-6). (Source: Family Practice News)

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  Determination of the mutant selection window for clindamycin, doxycycline, linezolid, moxifloxacin and trimethoprim/sulfamethoxazole against community-associated meticillin-resistant Staphylococcus aureus (MRSA)

In this study, mutant prevention concentration (MPC) testing was used to investigate the propensity for future resistance induction in CA-MRSA by clindamycin, doxycycline, linezolid, moxifloxacin and trimethoprim/sulfamethoxazole. Four CA-MRSA isolates [two each of clones USA300 (10841 and NRS384) and USA400 (2833 and NRS123)] were tested as well as a single hospital-acquired strain (NRS385). A variable hierarchy of the tested antimicrobials with respect to the percentage of the dosage interval that concentrations fall within the mutant selection window (%TMSW) was determined, with all antimicrobials achieving %TMSW values >20%. Against the hospital-acquired strain, all antimicrobials except linezolid (%TMSW=74.10%) and moxifloxacin (%TMSW=21.65%) are predicted to attain concentrations bel...

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  SULFAMETHOXAZOLE-TRIMETHOPRIM (SMZ)Tablet [AvKARE, Inc.]

Updated Date: Nov 12, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Clinical efficacy of first- and second-line treatments for HIV-associated Pneumocystis jirovecii pneumonia: a tri-centre cohort study

Conclusions Pentamidine was associated with a greater risk of death when used as first- and second-line therapy for HIV-associated PCP, and was associated with more treatment changes. Clindamycin/primaquine appeared superior to pentamidine as second-line therapy for PCP in patients failing or developing toxicity with trimethoprim/sulfamethoxazole. In patients failing first-line treatment with non-trimethoprim/sulfamethoxazole regimens, second-line therapy should be trimethoprim/sulfamethoxazole. (Source: Journal of Antimicrobial Chemotherapy)

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  BACTRIM DS (Sulfamethoxazole And Trimethoprim) Tablet BACTRIM (Sulfamethoxazole And Trimethoprim) Tablet [AR Scientific Inc.]

Updated Date: Nov 9, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Successful treatment of immune reconstitution inflammatory syndrome in Whipple's disease using thalidomide

Summary: A patient with classic Whipple's disease developed erythema nodosum leprosum-like lesions and fever one month after the beginning of an accurate therapy with trimethoprim-sulfamethoxazole. Immune reconstitution inflammatory syndrome was suspected, but corticosteroid therapy failed to improve the patient. Finally, thalidomide was used and successfully induced rapid improvement. (Source: Journal of Infection)

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  In vitro susceptibility of Achromobacter spp. isolates: comparison of disk diffusion, Etest and agar dilution methods

In this study, we analysed the antimicrobial susceptibility of 92 strains of Achromobacter spp. isolated from clinical samples to 18 antimicrobial agents. The disk diffusion method and Etest were compared with the agar dilution method, and the breakpoints of susceptibility and resistance for the disk diffusion method for the antimicrobials tested were determined. The most active antibiotics were piperacillin, piperacillin/tazobactam and the carbapenems. By applying the linear least-squares regression method, breakpoints could be established for antibiotics active against this genus such as imipenem, meropenem, ertapenem and trimethoprim/sulfamethoxazole (SXT). Other active antibiotics, such as piperacillin and minocycline, could be tested by the Etest method. The less active antibiotics su...

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  Development of a gene transfer-based treatment for radiation-induced salivary hypofunction

Abstract: A significant long-term side effect of radiation therapy for head and neck cancers is xerostomia, a dry mouth, due to salivary gland damage. Despite continuing efforts to eliminate this problem, many patients continue to suffer. This brief review describes our efforts to develop a gene transfer approach, employing the aquaporin-1 cDNA, to treat patients with existing radiation-induced salivary hypofunction. A Phase I/II clinical trial, using a recombinant adenoviral vector to mediate gene transfer, is currently underway. (Source: Oral Oncology)

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  Trimethoprim-sulfamethoxazole induced acute interstitial nephritis in renal allografts; clinical course and outcome.

Conclusions: AIN secondary to TMP-SMX, although an uncommon cause of allograft dysfunction over the study period, accounted for over 10% of cases of allograft dysfunction within the first month of transplantation. Therefore, a high degree of clinical suspicion for TMP-SMX-induced AIN is warranted when confronted with early acute allograft dysfunction. PMID: 19863874 [PubMed - in process] (Source: Clinical Nephrology)

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  A Survival Case of ABO-Incompatible Liver Transplantation Complicated With Severe Preoperative Infection and Subsequent Overwhelming Postsplenectomy Infection

Abstract: A 47-year-old Japanese man was transferred to our hospital because of acute-on-chronic hepatitis B virus infection. On admission, he was suffering from sepsis due to a catheter infection and respiratory failure caused by pulmonary edema and pneumonia, but, as a result of preoperative intensive care, we avoided septic shock. ABO-incompatible liver transplantation (ABO-I-LT) was performed. In accordance with our ABO-I-LT protocol, we administered, rituximab and performed plasma exchange, splenectomy as well as hepatic artery infusion. The patient was discharged 80 days after living donor transplantation (LDLT). However, 136 days after LDLT, he experienced recurrent respiratory failure due to severe pneumonia. At that time, the CD19+ B-cell count in the peripheral blood flow remaine...

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  Antibiotic Prophylaxis Cuts Recurrent UTI a Bit

Long-term, low-dose trimethoprim-sulfamethoxazole “modestly” decreases the number of urinary tract infections in predisposed children. However, it remains unknown whether this effect translates into preventing kidney damage from pyelonephritis, and “the magnitude of the benefit is likely to be small at best,” said Dr. Jonathan C. Craig of the University of Sydney and his associates. (Source: Pediatric News)

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  Long-Term Use of Trimethoprim-Sulfamethoxazole May Reduce UTIs in At-Risk Children

In a randomized trial, long-term, low-dose trimethoprim-sulfamethoxazole shows a consistent but modest treatment effect across subgroups of children with urinary tract infections. Medscape Medical News (Source: Medscape Today Headlines)

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  Antibiotic prophylaxis and recurrent urinary tract infection in children

Source: N Engl J Med Area: News Long-term, low-dose trimethoprim-sulfamethoxazole prophylaxis was associated with a decreased number of urinary tract infections (UTIs) in predisposed children, according to a report in the New England Journal of Medicine.   The findings come from a study conducted at four Australian centres in 576 children under the age of 18 years (median age at entry 14 months) who had had one or more microbiologically proven UTI. Amongst this group, 64% were girls, 42% had vesicoureteral reflux, and 71% were enrolled after the first diagnosis of UTI. They were randomised to receive either daily trimethoprim-sulfamethoxazole suspension (2mg/kg trimethoprim plus 10mg/kg sulfamethoxazole) or placebo for 12 months. The primary outcome was microbiologically confirme...

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  A multidimensional high performance liquid chromatography method coupled with amperometric detection using a boron-doped diamond electrode for the simultaneous determination of sulfamethoxazole and trimethoprim in bovine milk.

Authors: Andrade LS, de Moraes MC, Rocha-Filho RC, Fatibello-Filho O, Cass QB The development and validation of a multidimensional HPLC method using an on-line clean-up column coupled with amperometric detection employing a boron-doped diamond (BDD) electrode for the simultaneous determination of sulfamethoxazole (SMX) and trimethoprim (TMP) in bovine milk are presented. Aliquots of pre-prepared skim-milk samples were directly injected into a RAM octyl-BSA column in order to remove proteins that otherwise would interfere with milk analysis. After exclusion of the milk proteins, SMX and TMP were transferred to the analytical column (an octyl column) and the separation of the compounds from one another and from other endogenous milk components was achieved. SMX and TMP were detected ampe...

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  Value of anti-infective chemoprophylaxis in primary systemic vasculitis.What is the evidence?

Although infections are a major concern in patients with primary systemic vasculitis the actual knowledge about risk factors and the evidence concerning the use of anti-infective prophylaxis from clinical trials are scarce. The use of high dose glucocorticoids and cyclophosphamide pose a definite risk for infections. Bacterial infections are among the most frequent causes of death, with Staph. aureus being the most common isolate. Concerning viral infections cytomegalovirus and varicella-zoster virus reactivation represent the most frequent complications. The only prophylactic measure which is widely accepted is trimethoprim/sulfamethoxazole to avoid pneumocystis jiroveci pneumonia in small vessel vasculitis patients with generalised disease receiving therapy for induction of remission. (S...

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  Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy would prevent urinary tract infection in children (under the age of 18 years) who had already had one or more microbiologically proven urinary tract infections. Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a modest decrease in the number of urinary tract infections in predisposed children. (Source: New England Journal of Medicine)

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  Listeriosis Prophylaxis May Be Warranted in High-Risk Transplant Patients

Listeriosis is rare but often fatal in solid-organ transplant recipients, and prophylaxis with trimethoprim-sulfamethoxazole may be warranted in patients at highest risk, according to Spanish researchers. Reuters Health Information (Source: Medscape Transplantation Headlines)

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  Clindamycin-primaquine versus pentamidine for the second-line treatment of pneumocystis pneumonia

Abstract  There are limited data on the efficacy of alternative regimens for treating patients with pneumocystis pneumonia (PCP). We compared the efficacy of clindamycin-primaquine (C-P) with that of pentamidine as a secondline treatment for PCP. Among 91 patients receiving trimethoprim-sulfamethoxazole (TMP-SMX) as a first-line treatment for PCP, 31 (34%) did not respond and 7 (8%) had adverse reactions. Fourteen patients received C-P and 9 received pentamidine as a second-line regimen because of treatment failure or an adverse reaction to TMP-SMX. The response rate of patients to C-P was higher than the response rate to pentamidine (9/14; 64% vs 1/9; 11%; P = 0.03). Content Type Journal ArticleCategory NoteDOI 10.1007/s10156-009-0710-zAuthors Tark Kim, Asan Medical Ce...

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  Second-line salvage treatment of AIDS-associated Pneumocystis jirovecii pneumonia: a case series and systematic review

Source: DARE Area: Evidence > Disease Focused Reviews CRD Summary: The authors concluded that trimethoprim-sulfamethoxazole should be used as second-line treatment for patients with AIDS-associated Pneumocystis jirovecii pneumonia who fail first-line treatment with other regimens. The limited search, incomplete reporting of review methods, differences between studies and lack of direct comparisons between treatments meant that the authors' conclusions may not be reliable. [For second-line treatment most studies used pentamidine; other studies used trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin-primaquine (C-P), or atovaquone.] CRD Commentary: The review question was clearly stated. Inclusion criteria were defined for intervention, participants, outcomes and study design. Althoug...

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  Med Sci Monit 2009; 15(11):CR579-582 "Susceptibility pattern of E. coli-associated urinary tract infection (UTI): A comparison of spinal cord injury-related and nosocomial UTI"

Conclusions: Despite more risk factors for antibiotic-resistant E. coli in SCI patients, antibiotic-resistant E. coli was observed more in nosocomial UTIs, which may be attributable to the hospital environment. (Source: Medical Science Monitor)

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  Med Sci Monit 2009; 15(11):PI61-65 "Prevalence and antimicrobial susceptibility of Escherichia coli in outpatient urinary isolates in Izmir, Turkey"

Conclusions: The most important finding of our study is that a considerable proportion of the studied E. coli isolates were resistant to most antibiotics except amikacin. These data provide useful information for clinicians in determining the appropriate empirical antimicrobial regimen, and help authorities to formulate antibiotic prescription policies. (Source: Medical Science Monitor)

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  Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia

Conclusion: Clinicians should be aware that cystic lesions and bronchiectasis can develop in spite of trimethoprim/sulfamethoxazole treatment for P. jirovecii pneumonia. The newly formed bronchiectasis and cyst formation that were noted in follow up high resolution computed tomography (HRCT) but were not visible on HRCT at admission could be risk factors for the development of pneumothorax or pneumomediastinum with subcutaneous emphysema in HIV-patients. (Source: BMC Infectious Diseases)

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  Detection of antibiotic resistant E. coli and Enterococcus spp. in stool of healthy growing children in Portugal

From stool specimens of 118 healthy children's (1-14 years) in Portugal 92 E. coli and 101 Enterococcu s spp. strains have been isolated. Almost half (40.2%) of the E. coli isolates were resistant to ampicillin, 25.0% were resistant to tetracycline and 26.1% were resistant to streptomycin. Resistance genes detected by specific PCR included blaTEM and/or blaSHV and/or blaCTX-M (33 of 37 ampicillin and/or cefotaxime resistant isolates), tet (A) and/or tet (B) (16 of 23 tetracycline-resistant isolates), aad A (19 of 24 streptomycin-resistant isolates), cml A (in the two chloramphenicol-resistant isolates), aac (3)-II with/without aac (3)-IV (in the four gentamicin-resistant isolates), sul 1 and/or sul 2 and/or sul 3 (in all trimethoprim/sulfamethoxazole resistant isolates). The majority of th...

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  Detection and characterization of class 1 integrons in Aeromonas spp. isolated from human diarrheic stool in Mexico

We determined the presence of class 1 integrons related to the acquisition of resistance to antimicrobials in Aeromonas spp. isolated from individuals with diarrhea. Species were identified as A. caviae, A. hydrophila, A. veronii and A. media using PCR-RFLP of the 16S rDNA. Selected isolates were further characterized by ERIC-PCR. Resistance to chloramphenicol, aztreonam, tetracycline, trimethoprim/sulfamethoxazole, nalidixic acid and streptomycin, among others, was determined using the Kirby-Bauer method. Integrons were detected by PCR amplification of the 5[prime] conserved, variable, and 3[prime] conserved regions. Sequencing of the variable regions revealed class 1 integrons with cassettes encoding resistance to trimethoprim (dfrA12, dfrA15, dfrB4), streptomycin/spectinomycin (aadA2, a...

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  Emergence of multidrug-resistant Salmonella enterica serovar Typhi with reduced susceptibility to fluoroquinolones in Cambodia

Abstract: From December 2006 to April 2009, we conducted an etiology study among Cambodian patients presenting with acute fever of unknown origin. Salmonella enterica serovar Typhi was detected in 0.9% (41/4985) blood cultures. Antimicrobial susceptibility testing showed decreased susceptibility to ampicillin (56% resistant; MIC90, >256 μg/mL), chloramphenicol (56% resistant; MIC90, >256 μg/mL), trimethoprim/sulfamethoxazole (56% resistant; MIC90, >256 μg/mL), nalidixic acid (81% resistant; MIC90, not defined), ciprofloxacin (0% resistant; MIC90, 0.5 μg/mL), and ceftriaxone (0% resistant; MIC90, 0.094 μg/mL). Multidrug resistance, defined as antimicrobial resistance to ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, was found in 56% of the isolates, and 80% had reduced...

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  Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh’s A and B patients

Conclusions  Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence. Content Type Journal ArticleCategory Original Article—Liver, Pancreas, and Biliary TractDOI 10.1007/s00535-009-0134-7Authors Leonardo Trevizan Monici, State University of Campinas (Unicamp) Gastroenterological Diagnosis and Research Center (Gastrocentro) Rua Carlos Chagas 420, Cidade Universitária Zeferino Vaz Campinas SP 13031-970 BrazilJosé Olympio Meirelles-Santos, State University of Campinas (Unicamp) Gastroenterological Diagnosis and Research Center (Gastrocentro) Rua Carlos Chagas 42...

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  Vitamin D Metabolite–Mediated Hypercalcemia With Suppressed Parathormone Concentration in Pneumocystis jiroveci Pneumonia After Kidney Transplantation

Abstract: Pneumocystis jiroveci pneumonia (PJP) is a severe complication in immunocompromised hosts including transplant recipients. Hypercalcemia (HCa) is not a classic symptom of the disease. However, HCa (mean [SD; range], 2.90 [0.20; 2.71–3.17] mmol/L) was detected in 5 patients with PJP at diagnosis. The HCa was associated with decreased concentrations of circulating parathormone (PTH), from 294 (292) ng/L 3 to 6 months previously to 20 (23.5; 7–53) ng/L. Concentrations of 1,25-(OH)2 vitamin D, measured in 3 patients, were in the high normal range (54.66 [7.23; 225–66] μg/L), whereas 25-(OH) vitamin D concentrations were low (13.9 [2.17; 20–60] μg/L). After treatment with trimethoprim-sulfamethoxazole for 21 days, 4 patients recovered and 1 died. Calcium and PTH concentratio...

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  Antimicrobials effective for inhibition of enterohaemorrhagic Escherichia coli strains O26, O111, and O157 and their effects on Shiga toxin releases.

Authors: Lee JH, Stein B Susceptibilities of major enterohaemorrhagic Escherichia coli (EHEC) strains to antimicrobial agents and the cytotoxicity of these agents were examined using a total of 38 strains of E. coli O26, O111, and O157, which are the major serogroups of EHEC. Among the 38 strains, 35, 36, and 36 were susceptible to amikacin, imipenem and norfloxacin, respectively. These antimicrobial agents were further examined to determine their cytotoxicity on Vero cells as well as their effect on the release of Shiga toxins along with trimethoprim/sulfamethoxazole. Each of the E. coli O26, O111, and O157 strains containing both stx1and stx2 genes were grown in the absence or presence of these agents at 1/4 minimal inhibitory concentration for 6 h, 12 h, and 18 h. At the concentrati...

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  Case Report of Pediatric Gastroenteritis Due to CTX-M-15 Extended-Spectrum beta-Lactamase-Producing Salmonella enterica Serotype Enteritidis.

Authors: Lee KH, Song W, Jeong SH, Choi KY, Yoon HS, Park MJ A clinical isolate of Salmonella enterica serotype Enteritidis in Korea was found to produce the extended-spectrum beta-lactamase CTX-M-15. The isolate was recovered in 2008 from the stool of a 3-yr-old boy with gastroenteritis. This isolate was found to be resistant to multiple drugs, including ampicillin, piperacillin, cefotaxime, ceftazidime, cefepime, and aztreonam. The resistance to cefotaxime was transferred by conjugation to recipient Escherichia coli J53. The patient was eventually successfully treated with trimethoprim-sulfamethoxazole. This is the first report of the bla (CTX-M-15) gene in S. enterica serotype Enteritidis in Korea. PMID: 19893356 [PubMed - in process] (Source: The Korean Journal of Laboratory Me...

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  Invasive non-typhoidal Salmonella in Mozambican children

Conclusions Clinical presentation of invasive NTS was non-specific and similar to that of other infections, with some factors being associated with NTS. Antibiotic resistance was very common to currently recommended and available antibiotics for suspected sepsis. (Source: Tropical Medicine and International Health)

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  Short- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: a meta-analysis of randomized controlled trials

Source: DARE Area: Evidence > Disease Focused Reviews CRD Summary: This reasonably well-conducted review compared short and long-course treatments with the same antibiotic in the treatment of acute pyelonephritis. The authors concluded that there were no significant differences in efficacy or tolerability between the two courses. This conclusion is based on a small number of patients but is otherwise likely to be reliable. [Included trials used the following antibiotic regimes: intravenous fleroxacin followed by oral fleroxacin; oral ampicillin or oral trimethoprim plus sulfamethoxazole; oral pivampicillin plus pivmecillinam; or intravenous gentamicin or tobramycin followed by one of three antibiotics orally. ] CRD Commentary: The review question and the inclusion criteria were clear....

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  In vitro activity of ceftazidime, ciprofloxacin, meropenem, minocycline, tobramycin and trimethoprim/sulfamethoxazole against planktonic and sessile Burkholderia cepacia complex bacteria

Conclusions Despite the general assumption that sessile cells show a decreased susceptibility to antibiotics, our data indicate similar bacteriostatic and bactericidal activity of six selected antibiotics against planktonic and sessile B. cepacia complex bacteria. (Source: Journal of Antimicrobial Chemotherapy)

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  Influence of concomitant prednisolone on trimethoprim-associated hyperkalaemia

Conclusions Although it is possible that there is an unexplained interaction between trimethoprim and prednisolone, we postulate that our observation is a result of the catabolic effect of prednisolone. The patients treated with trimethoprim–sulfamethoxazole plus prednisolone appear to be more likely to develop hyperkalaemia than patients treated with trimethoprim–sulfamethoxazole alone. (Source: Journal of Antimicrobial Chemotherapy)

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  Understanding of pediatric antimicrobial prescriptions at health units in a Southern Brazil city

O objetivo do estudo foi avaliar a compreensão da prescrição de antimicrobianos por acompanhantes de crianças após consulta pediátrica, descrevendo seu perfil de prescrição em Unidades de Saúde, em um município do sul do Brasil. Trata-se de um delineamento transversal, no qual a população-alvo foram acompanhantes das crianças que tiveram prescrição de antimicrobianos (n = 209) entre maio e julho de 2007. Foi gerado um escore de compreensão (4-12 pontos) embasado em afirmativas corretas, incorretas ou ignoradas, relativas às informações da prescrição. A compreensão foi considerada adequada quando o valor do escore foi menor do que 6,5 pontos. Verificou-se que a escolaridade (p = 0,05), renda (p = 0,03), cor da pele (p = 0,007) do acompanhante e o tempo de consulta (p =...

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  Distribution of Class I Integron and Sulfamethoxazole Trimethoprim Constin in Vibrio cholerae Isolated from Patients in Iran

Microbial Drug Resistance Sep 2009, Vol. 15, No. 3: 179-184. (Source: Microbial Drug Resistance)

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  Comparison of clonal relatedness and antimicrobial susceptibility of fecal Escherichia coli from healthy dogs and their owners.

Conclusions and Clinical Relevance-Within-household sharing of E coli was detected more commonly than across-household sharing, but both direct contact and environmental reservoirs may be routes of cross-species sharing of bacteria and genes for resistance. Cross-species bacterial sharing is a potential public health concern, and good hygiene is recommended. PMID: 19719426 [PubMed - in process] (Source: American Journal of Veterinary Research)

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  Emergence of Extended-Spectrum Beta-Lactamases in Clinical Isolates of Salmonella enterica in Tehran, Iran.

Authors: Hamidian M, Tajbakhsh M, Walther-Rasmussen J, Zali MR The purpose of the current study was to investigate the presence and molecular type(s) of extended-spectrum beta-lactamases (ESBLs) in Salmonella spp. isolates obtained from patients with diarrhea in hospitals of Tehran, Iran. Over a period of 17 months, 129 Salmonella spp. were isolated from fecal samples and tested for susceptibility using the Kirby-Bauer disk diffusion method; then, screening for ESBL-producing isolates and determination of their minimum inhibitory concentrations were carried out using the combined disk method and standard agar dilution method, respectively. The presence and type of ESBL-encoding genes were determined by PCR and sequence analysis. The isolates were all identified as Salmonella enterica o...

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  Adult with painful pruritic plaques

A 27-year-old white male presented with a 1-year history of a progressive, painful, pruritic eruption in his scalp, axillae, and inguinal area. Apart from occasional alcohol use, the patient was otherwise healthy and had no systemic complaints. He had no family history of malignancy or similar skin conditions. He reported minimal improvement with oral trimethoprim/sulfamethoxazole and topical triamcinolone ointment. The clinical examination revealed that his scalp was diffusely erythematous with yellow-brown adherent crusts. Vegetative, macerated, and eroded plaques with purulent discharge were noted in the axillae, intergluteal crease, and inguinal region ( and ). He had no oral or ocular lesions. (Source: Journal of the American Academy of Dermatology)

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  Isospora belli infection after isolated intestinal transplant

F. Gruz, C. Fuxman, A. Errea, M. Tokumoto, A. Fernandez, J. Velasquez, C. Nagel, A. Ruf, E. Mauriño, F. Nachman, M. Rumbo, G. Gondolesi. Isospora belli infection after isolated intestinal transplant.Transpl Infect Dis 2009. All rights reservedAbstract: Isospora belli is a protozoan that only affects humans, after ingestion of Isospora's oocysts. Immunocompetent patients usually do not develop the infection. Immunocompromised hosts may have profuse diarrhea with other gastrointestinal symptoms. Treatment is based on trimethoprim-sulfamethoxazole. In 2006 we performed an isolated intestinal transplantation in a patient with ultra-short bowel syndrome. Neither rejection nor clinical problems occurred after transplant, but signs of intestinal inflammation were seen in every protocol biopsy st...

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  ORIGINAL CONTRIBUTION: Typhoid Fever in the United States, 1999-2006

Conclusion  Infection with antimicrobial-resistant S Typhi strains among US patients with typhoid fever is associated with travel to the Indian subcontinent, and an increasing proportion of these infections are due to S Typhi strains with decreased susceptibility to fluoroquinolones. (Source: JAMA)

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  Incidence, Risk Factors, and Outcomes of Klebsiella pneumoniae Bacteremia

Conclusion: This is the first population-based study to document the major burden of illness associated with K. pneumoniae bacteremia and identifies groups at increased risk of acquiring and dying of these infections. (Source: The American Journal of Medicine)

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  Excretion of Antimicrobials Used to Treat Methicillin-Resistant Staphylococcus aureus Infections During Lactation: Safety in Breastfeeding Infants

Pharmacotherapy 29(9): 1103-1109 Abstract Community-acquired strains of methicillin-resistant Staphylococcus aureus (MRSA) have become a common cause of skin and soft tissue infections in the United States. These infections sometimes require treatment with antibiotics, and with the increasing resistance of pathogens to these agents, choosing the appropriate drug can be difficult. In lactating women who develop these infections, selecting an antibiotic is even more challenging, as clinicians need to be aware of risks to the infant from the drug excreted during lactation. To our knowledge, no review has addressed the safety of antibiotics in breastfeeding infants when the drugs are used to treat maternal skin and soft tissue infections from MRSA. Thus, we performed a literature search of the...

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  Removal of antibiotics and non-steroidal anti-inflammatory drugs by extended sludge age biological process.

Authors: Yu TH, Lin AY, Lateef SK, Lin CF, Yang PY Removal of four antibiotics (sulfamethoxazole, sulfadimethoxine, sulfamethazine and trimethoprim) and four non-steroidal anti-inflammatory drugs (acetaminophen, ibuprofen, ketoprofen and naproxen) using extended sludge age biological process was investigated. The sludge age of the biological system was greater than 200d. Hydraulic retention time of 12h was maintained throughout the experiment. The extended sludge age biological process is able to treat pharmaceuticals with good and steady removal efficiencies: 64-93% removal for antibiotics over 1-5mugL(-1) influent concentrations and 94% to complete removal for acetaminophen and ibuprofen with a wide range of influent concentrations 1-100mugL(-1). For ketoprofen and naproxen the remov...

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  Isolation and Molecular Characterization of Multidrug-Resistant Strains of Escherichia coli and Salmonella from Retail Chicken Meat in Japan

Sixty-nine Escherichia coli and 10 Salmonella isolates, recovered from retail chicken meat in Hiroshima prefecture, Japan, were assayed for antimicrobial susceptibility, the presence of integrons and antimicrobial resistance genes. Twenty-eight out of 69 (40.6%) of E. coli and all 10 Salmonella isolates were exhibited multidrug resistance phenotypes. The most commonly reported resistance phenotypes were against ampicillin, streptomycin, spectinomycin, kanamycin, tetracycline, and trimethoprim/sulfamethoxazole. PCR screening for integrons showed that 8 (11.6%) of the E. coli isolates were positive for the class 1 integrons and 1 isolate (1.4%) was positive for the class 2 integrons. Among the 10 Salmonella isolates, 9 were positive for class 1 integrons and none was positive for class 2 int...

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  Distribution of integron-associated trimethoprim–sulfamethoxazole resistance determinants among Escherichia coli from humans and food-producing animals

Conclusions: More animal faecal isolates carry class 1 integrons than human faecal and human urinary isolates, and the distribution of phylogenetic groups is common across animal and human faecal isolates but different from human urinary isolates.Significance and Impact of the Study: Commensal isolates from food-producing animals are an important reservoir for integrons carrying antibiotic resistance genes. (Source: Letters in Applied Microbiology)

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  Linking Pneumocystis jiroveci sulfamethoxazole resistance to the alleles of the DHPS gene using functional complementation in Saccharomyces cerevisiae

Clin Microbiol Infect Curative and prophylactic therapy for Pneumocystis jiroveci pneumonia relies mainly on cotrimoxazole, an association of trimethoprim and sulfamethoxazole (SMX). SMX inhibits the folic acid pathway through competition with para-aminobenzoic acid (pABA), one of the two substrates of the dihydropteroate synthase (DHPS), a key enzyme in de novo folic acid synthesis. The most frequent non-synonymous single nucleotide polymorphisms (SNPs) in P. jiroveci DHPS are seen at positions 165 and 171, the combination leading to four possible different genetic alleles. A number of reports correlate prophylaxis failure and mutation in the P. jiroveci DHPS but, because of the impossibility of reliably cultivating P. jiroveci, the link between DHPS mutation(s) and SMX susceptibility is ...

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  [Activity of Ertapenem and Ceftriaxone in the eradication of Salmonella in a model of experimental peritonitis in mice.]

Authors: Lozano F, García M, García E, González B, García M, García F, García J Since the beginning of the 1990s, the prevalence of isolates of non-typhoidal Salmonella species resistant to antimicrobial agents, including those commonly used for the treatment of Salmonella infections such as fluoroquinolones, trimethoprim-sulfamethoxazole or beta-lactams, has increased substantially. Infections caused by multidrugresistant strains of non-typhoidal Salmonella are now frequently encountered. In order to consider an appropriate role of Ertapenem in Salmonella-due intraabdominal infections, in the present study we compare the efficacy of Ertapenem versus that of Ceftriaxone in a mouse peritonitis model. Bacteriological eradication from blood, liver and mesente...

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  Norfloxacin Modulates the Inflammatory Response and Directly Affects Neutrophils in Patients With Decompensated Cirrhosis

Conclusions: Norfloxacin but not trimethoprim/sulfamethoxazole modulates inflammatory response and directly affects neutrophils in patients with cirrhosis. (Source: Gastroenterology)

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  Methicillin-Resistant Staphylococcus Aureus as a Common Cause of Vulvar Abscesses: Thurman AR, Satterfield TM, Soper DE. Obstet Gynecol 2008;112:538–44

This retrospective chart review from San Antonio, Texas reports the incidence of methicillin-resistant Staphylococcus aureus (MRSA) from vulvar abscesses in women presenting to the emergency department in an urban, low income, primarily Hispanic community. Sixty-four percent of 133 women with vulvar abscess had MRSA isolated from abscess culture. Ninety-six percent of isolated MRSA was sensitive to trimethoprim-sulfamethoxazole. The authors also report characteristics associated with inpatient (40%) vs. outpatient treatment of abscess and found that inpatients more often had diabetes, hypertension, larger abscess, and higher white blood cell counts. Ninety-six percent of inpatients received incision and drainage of the abscess in the operating room. The authors highlight the need to cover ...

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  Reply

As urologists we must be aware of the increasing resistance to fluoroquinolones and do what we can to slow this concerning phenomenon. Although we usually treat patients with complicated urinary tract infections, we occasionally treat a patient with an uncomplicated infection and need to ensure that we hold ourselves and our colleagues in primary care to the current standard of care. Acute bacterial urinary tract infection is one of the most common infections encountered and treated in outpatients. According to the 1999 Infectious Diseases Society of America Guidelines for Antimicrobial Treatment of Uncomplicated Acute Bacterial Cystitis and Acute Pyelonephritis in Women, the use of trimethoprim-sulfamethoxazole for three days is the current standard therapy for uncomplicated bacterial uri...

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  Antimicrobial non-susceptibility of cervico-vaginal and rectal Escherichia coli isolates is associated with phylogeny and plasmid carriage

Abstract  Uropathogenic Escherichia coli (UPEC) is the primary cause of urinary tract infections (UTIs) in adult women, which are increasingly refractory to antimicrobial treatment. UPEC colonizes the vagina prior to causing a UTI. Our hypothesis was that the vaginal flora would be enriched in UPEC and therefore have a greater prevalence of non-susceptibility relative to the rectal flora. We used disk diffusion to determine the antimicrobial susceptibilities of 100 cervico-vaginal E. coli (CVEC) and 100 rectal E. coli (REC) isolates from 200 different patients. Phylogeny, plasmid replicons, and antimicrobial resistance genes were detected by polymerase chain reaction (PCR). There were no significant differences between CVEC and REC, and the overall levels of non-susceptibili...

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  Comparison of sales and reimbursement data regarding outpatient antibiotic use in a northern Italian Region

To evaluate the accuracy of systemic antibiotic use statistics, based on the reimbursement data of the Emilia-Romagna Region (Italy), focusing on agents prescribed for urinary tract infections.Reimbursement data were obtained from the drug prescription database that includes all outpatient drug prescriptions reimbursed by the Regional Health Service in 2007. Reimbursements were compared to sales data, provided by International Medical Statistics (IMS) Health.The reimbursement data of the Emilia-Romagna Region significantly underestimates the actual use of systemic antibiotics when compared to sales. The overall underestimation of antibiotic use is 19%, ranging from 7% for second-third-generation cephalosporins to 98% for nitrofurantoin. Considering agents prescribed for urinary tract infec...

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  Dosing regimens of cotrimoxazole (trimethoprim-sulfamethoxazole) for melioidosis.

Authors: Cheng AC, McBryde ES, Wuthiekanun V, Chierakul W, Amornchai P, Day NP, White NJ, Peacock SJ Melioidosis is an infectious disease with a propensity for relapse despite prolonged antibiotic eradication therapy for 12-20 weeks. A pharmacokinetic simulation study was performed to determine the optimal dosing of cotrimoxazole (trimethoprim-sulfamethoxazole; TMP-SMX) used in current eradication regimens in Thailand and Australia. Bioavailability, protein binding and coefficients of absorption and elimination were taken from published literature. Apparent volumes of distribution were correlated with body mass and were estimated separately for Thai and Australian populations. In vitro experiments demonstrated concentration-dependent killing. In Australia, the currently used eradicatio...

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  AAV5-mediated gene transfer to the parotid glands of non-human primates

Authors: A Voutetakis, C Zheng, A P Cotrim, F Mineshiba, S Afione, N Roescher, W D Swaim, M Metzger, M A Eckhaus, R E Donahue, C E Dunbar, J A Chiorini & B J Baum (Source: Gene Therapy)

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  AAV5-mediated gene transfer to the parotid glands of non-human primates

Authors: A Voutetakis, C Zheng, A P Cotrim, F Mineshiba, S Afione, N Roescher, W D Swaim, M Metzger, M A Eckhaus, R E Donahue, C E Dunbar, J A Chiorini & B J Baum (Source: Gene Therapy)

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  Flare-up of patch test of trimethoprim–sulfamethoxazole (co-trimoxazole) during oral desensitization

(Source: Contact Dermatitis)

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  Trimethoprim-Sulfamethoxazole Exposure Alters Ex Vivo Function of B Lymphocytes Isolated From Human Immunodeficiency Virus-Infected Patients Receiving Zidovudine

Functional status of peripheral B-lymphocytes following treatment with trimethoprim-sulfamethoxazole in patients with HIV infection: What is the impact on host defense? Pharmacotherapy (Source: Medscape Pharmacist Headlines)

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  Evolution of antimicrobial resistance in enteroaggregative Escherichia coli and enterotoxigenic Escherichia coli causing traveller's diarrhoea

Conclusions The high percentage of resistance to quinolones in ETEC and EAEC isolated from travellers to North Africa and India is a matter for concern. These agents should therefore be used with caution in patients with traveller's diarrhoea returning from these geographical areas. (Source: Journal of Antimicrobial Chemotherapy)

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  Generic Antibiotic Maker Gets Summary Judgment On Learned Intermediary

ROCKFORD, Ill. - A prescribing doctor who was aware that the antibiotic sulfatrim (generic for Bactrim) had a risk of Stephens-Johnson Syndrome (SJS) is a learned intermediary that protects a generic drug manufacturer and pharmacy from a product liability claim, an Illinois federal judge ruled June 10 in granting summary judgment (Mary Catherine T. Stephens v. CVA Pharmacy, et al., No. 06-50177, N.D. Ill.). Full story on lexis.com (Source: LexisNexis® Mealey's™ Emerging Drugs & Devices Legal News)

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  Prevention of Radiation-Induced Oral Mucositis after Adenoviral Vector-Mediated Transfer of the Keratinocyte Growth Factor cDNA to Mouse Submandibular Glands.

CONCLUSIONS: hKGF gene transfer to salivary glands prevented radiation-induced oral mucositis in mice. This proof of concept study suggests that transgenic hKGF secreted from transduced salivary glands may be useful clinically to prevent oral mucositis caused by radiation. PMID: 19584147 [PubMed - as supplied by publisher] (Source: Clinical Cancer Research)

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  What Are the Presenting Problems of Staphylococcus in Neonates?

Discussion Staphylococcus sp. are gram-positive, catalase-positive cocci that cluster when viewed microscopically. There are 17 species indigenous to humans and 13 colonize humans. Staphylococcus aureus is the only species that produces coagulase. Staphylococcus sp. can be found in almost any environment including high salt, low oxygen, high heat and low moisture. Coagulase-negative Staphylococcus sp. are so common that newborn infants are colonized by 2-4 days of life usually with S. epidermidis and S. haemolyticus. Staphylococcus aureus produces many infections especially pneumonia and surgical wound infections. Humans can be colonized with it especially in mucous membranes and the perineum and axilla. Those with nasal carriage can also transiently carry the organism on their hands, thu...

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  In vitro susceptibility of Burkholderia pseudomallei to antimicrobial peptides

In this study, the in vitro activities of 10 AMPs, including histatin 5 and histatin variants, human cathelicidin peptide LL-37 and lactoferrin peptides, against 24 isolates of B. pseudomallei were investigated. The results showed that the antibacterial activities of the individual peptides depended on peptide dose and bacterial isolate. Among the 10 peptides tested, LL-37 exhibited the most effective killing activity. The smooth type A lipopolysaccharide (LPS) phenotype B. pseudomallei appeared to be more susceptible than those expressing the smooth type B LPS and the rough type LPS. Four isolates of B. pseudomallei shown to be resistant to ceftazidime and trimethoprim/sulfamethoxazole were also highly susceptible to LL-37. These data indicate that LL-37 possesses antimicrobial activity a...

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  Treatment of head lice

Pediculosis capitis, or head lice, is a common infestation among children worldwide. Multiple therapies exist for the treatment of this condition, including topical pediculicides and oral medications. When used in combination with environmental decontamination, these drugs can be very effective in eradicating head lice infestation without significant adverse events. The present study discusses the use of available over-the-counter and prescription treatments, including pyrethroids and permethrin, lindane, malathion, ivermectin, and trimethoprim-sulfamethoxazole, in the treatment of head lice. (Source: Dermatologic Therapy)

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  Successful treatment of Stenotrophomonas maltophilia meningitis in a preterm baby boy: a case report

Conclusion: This organism should be considered as a potential cause of meningitis and trimethoprim-sulfamethoxazole and ciprofloxacin are a combination that is successful and safe for treating preterm infants. (Source: Journal of Medical Case Reports)

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  Cutaneous manfestations of Mycobacterium gordonae infection described for the first time in Italy: a case report

Conclusion: Advanced laboratory diagnostic techniques have improved the isolation and identification of nontuberculous mycobacteria. The diagnosis requires a high index of clinical suspicion, as detection by conventional methods is difficult. To our knowledge, this patient is the first documented case of cutaneous infection from this pathogen in Italy. (Source: Cases Journal)

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  Disseminated Nocardiosis: A Rare Infectious Complication Following Non–Heart-Beating Donor Liver Transplantation

Abstract: Nocardiosis is an infrequent disease that affects patients who display a cellular immunodeficiency, such as transplant recipients on immunosuppressive treatment, but uncommonly associated with high morbidity and mortality rates. Disseminated Nocardiosis affecting the central nervous system (CNS), abdomen, skin, and lungs has been described in bone marrow, lung, and kidney transplant recipients. However, to our knowledge, no cases involving all of these structures have been reported in liver transplant recipients. Herein, we have reported a case of CNS, pulmonary, and cutaneous nocardiosis in a liver transplant recipient who experienced hepatitis C virus–related cirrhosis and hepatocellular carcinoma and received the organ from a non–heart-beating donor. At posttransplantation...

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  Efficacy of Iclaprim against Wild-Type and Thymidine kinase-Deficient Methicillin-Resistant Staphylococcus aureus in an In Vitro Fibrin-Clot Model.

Authors: Entenza JM, Haldimann A, Giddey M, Lociuro S, Hawser S, Moreillon P Iclaprim is a novel diaminopyrimidine antibiotic active against methicillin-resistant Staphylococcus aureus (MRSA). However, it is known that the activity of diaminopyrimidines against S. aureus is antagonized by thymidine, through uptake and conversion to thymidylate by thymidine kinase. In contrast to humans, where thymidine levels are low, thymidine levels in rodents are high, thus precluding accurate evaluation of iclaprim efficacy in animal models. We have studied the bactericidal activity of iclaprim against an isogenic pair of MRSA isolates, the wild-type parent AW6 and its thymidine kinase-deficient mutant AH1252, in an in vitro fibrin-clot model. Clots, aimed at mimicking vegetation structure, were ma...

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  Tuberculosis and Trimethoprim-Sulfamethoxazole.

We examined how frequently Mycobacterium tuberculosis is sensitive to trimethoprim-sulfamethoxazole. Isolates were tested for susceptibility to trimethoprim-sulfamethoxazole on supplemented Middlebrook 7H10 plates. We found that 43 of 44 (98%) of isolates of M. tuberculosis were susceptible to the combination of </= 1microg/ml of trimethoprim and 19microg/ml of sulfamethoxazole (</=1/19microg/ml). Thus the vast majority of our M. tuberculosis isolates were susceptible to trimethoprim-sulfamethoxazole at an MIC similar to M. kansasii, M. marinum and sensitive rapidly growing mycobacteria, organisms successfully treated with trimethoprim-sulfamethoxazole as part of the treatment regimen. In an era of multiple and extended drug resistance in tuberculosis (MDR and XDR), it is possible th...

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  [Mutations of drug target molecules in Pneumocystis jirovecii isolates and future investigations]

Authors: Takahashi T Pneumocystis (Pc) jirovecii causes severe interstitial pneumonia in patients with immunodeficiency, in whom this fungus adheres with type-I alveolar epithelial cells. Therefore, it is important to perform quick diagnosis and treatment for Pc pneumonia (PcP). In general, a combination of two antifolate agents, sulfamethoxazole (inhibition of dihydropteroate synthase (DHPS)) and trimethoprim (inhibition of dihydrofolate reductase), is the first choice for PcP treatment, and pentamidine or atovaquone (inhibition of cytochrome b) are the alternative reagents for the therapy. Amino acid substitutions of drug-binding sites in DHPS shown in genotypic analysis have been reported to be associated with failures of prophylaxis / treatment or severe mortality for PcP, while th...

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  [Oral antibiotic treatment of urinary tract infections in children.]

Authors: Klingenberg C, Småbrekke L, Døllner H, Simonsen GS Urinary tract infection (UTI) is one of the most common bacterial infections in childhood. Empiric antibiotic therapy is guided by the clinical presentation, the patient's ability to take oral agents and the local resistance pattern of Escherichia coli (E. coli), the most common pathogen. Most children (with both upper and lower UTI) can safely be treated with oral antibiotics. We recommend pivmecillinam or amoxicillin-clavulanic acid as first-line empiric therapy for upper UTI. Amoxicillin and trimethoprim-sulfamethoxazole are no longer first-line oral agents due to increasing E. coli resistance to both drugs. For lower UTI nitrofurantoin is an excellent first choice. In Norway, lack of paediatric antibiotic syrups ...

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  GRAND ROUNDS: Evolving Health Effects of Pneumocystis: One Hundred Years of Progress in Diagnosis and Treatment

We present a patient with chronic lymphocytic leukemia who died from Pneumocystis pneumonia (PCP) despite appropriate anti-Pneumocystis therapy. Although substantial advances in diagnosis, treatment, and prevention of PCP have decreased its frequency and improved prognosis, PCP continues to be seen in both HIV-infected patients and patients receiving immunosuppressive medications. Pneumocystis species comprise a family of fungi, each of which appears to be able to infect only 1 host species. Pneumocystis has a worldwide distribution. Immunocompetent hosts clear infection without obvious clinical consequences. Pneumocystis has been identified in patients with other diseases such as chronic obstructive pulmonary disease, although its clinical impact is uncertain. Immunocompromised patients d...

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  IMAGING DIAGNOSIS—ACQUIRED GOITROUS HYPOTHYROIDISM FOLLOWING TREATMENT WITH TRIMETHOPRIM SULFAMETHOXAZOLE

(Source: Veterinary Radiology & Ultrasound)

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  Management of infection in patients with acute leukemia during chemotherapy in Japan: questionnaire analysis by the Japan Adult Leukemia Study Group.

In this study, we undertook a questionnaire survey of member institutions of the Japan Adult Leukemia Study Group to investigate the status of, and problems with, the management of infectious complications in patients with acute leukemia. The questionnaire consisted of 52 multiple-choice questions covering therapeutic environment, antibacterial, and antifungal prophylaxis, empirical therapy (ET) for FN, and use of G-CSF. The results were compared to a previous survey performed in 2001. Usable responses were received from 134 of 184 (71.7%) institutions. With regard to antibacterial prophylaxis, fluoroquinolones and sulfamethoxazole-trimethoprim were most commonly used. Regarding antifungal prophylaxis, the most frequently used agent was fluconazole, followed by itraconazole. In ET for FN, ...

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  Nocardia farcinica pericarditis after kidney transplantation despite prophylaxis

L. McPhee, P. Stogsdill, J.P. Vella. Nocardia farcinica pericarditis after kidney transplantation despite prophylaxis.Transpl Infect Dis 2009. All rights reserved A deceased-donor kidney transplant recipient developed purulent pericarditis caused by Nocardia despite trimethoprim[ndash]sulfamethoxazole (TMP[ndash]SMX) prophylaxis for Pneumocystis jirovecii. She was treated empirically with ceftriaxone and amikacin and subsequently underwent sternotomy with drainage of an intrapericardial abscess. Culture and susceptibility data demonstrated Nocardia farcinica, which was susceptible to SMX and amikacin, although resistant to ceftriaxone. Nocardia asteroides, the more common human pathogen, is generally susceptible to third-generation cephalosporins and TMP[ndash]SMX. N. farcinica is rare in ...

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  The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections

Abstract: The ARESC (Antimicrobial Resistance Epidemiological Survey on Cystitis) study is an international survey to investigate the prevalence and susceptibility of pathogens causing cystitis. Female patients (n=4264) aged 18–65 years with symptoms of uncomplicated cystitis were consecutively enrolled in nine European countries as well as Brazil during 2003–2006. Pathogens were identified and their susceptibility to nine antimicrobials was determined. Escherichia coli accounted for 76.7% of isolates. Among E. coli, 10.3% of the isolates were resistant to at last three different classes of antimicrobial agents. Resistance was most common to ampicillin (48.3%), trimethoprim/sulfamethoxazole (29.4%) and nalidixic acid (18.6%). Fosfomycin, mecillinam and nitrofurantoin were the most acti...

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  Antimicrobial resistance trends of Escherichia coli bloodstream isolates: a population-based study, 1998-2007

Conclusions To our knowledge, this is the first population-based study on antimicrobial resistance trends of E. coli bloodstream isolates in the USA. We demonstrated linear trends of increasing resistance among these isolates to three different classes of antimicrobial over the past decade. (Source: Journal of Antimicrobial Chemotherapy)

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  [Evaluation of the BD Phoenix Automated Microbiology System SMIC/ID-2 Panel for Antimicrobial Susceptibility Testing of Streptococcus pneumoniae.]

CONCLUSIONS: The Phoenix SMIC/ID-2 panel provided a simple and rapid susceptibility testing for S. pneumoniae, and the results were in a good agreement with those of Etest. The Phoenix system appears to be an effective automated system in clinical microbiology laboratories. PMID: 19571618 [PubMed - in process] (Source: The Korean Journal of Laboratory Medicine)

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  Daily Trimethoprim-Sulfamethoxazole Prophylaxis Rapidly Induces Corresponding Resistance Among Intestinal Escherichia coli of HIV-Infected Adults in Kenya

Conclusions. Daily prophylaxis with TMP-SMZ induced in vivo resistance to the drug after 2 weeks. Empiric therapy for diarrhea with agents other than TMP-SMZ should be considered for HIV-infected persons receiving daily TMP-SMZ prophylaxis. (Source: Journal of the International Association of Physicians in AIDS Care (JIAPAC))

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  Community-Associated Methicillin-Resistant Staphylococcus aureus Skin and Soft-Tissue Infection in HIV-Infected Patients

Conclusion. A majority of our patients with CA-MRSA SSTI did not have immunological/virological markers consistent with severe HIV/AIDS disease at time of presentation. (Source: Journal of the International Association of Physicians in AIDS Care (JIAPAC))

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  Empiric Antimicrobial Therapy for Pediatric Skin and Soft-Tissue Infections in the Era of Methicillin-Resistant Staphylococcus aureus

CONCLUSIONS. Compared with β-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, β-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections. (Source: PEDIATRICS)

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  Propofol infusion syndrome: case report and literature review.

CONCLUSION: Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol. PMID: 19420309 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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  Effective Pneumocystis jiroveci pneumonia prophylaxis with trimethoprim-sulfamethoxazole once a day twice a week

No Abstract. (Source: Pediatric Blood and Cancer)

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  Antibiotic Selection for Purulent Skin and Soft-Tissue Infections in Ambulatory Care: A Decision-Analytic Approach

Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused a nationwide epidemic of skin and soft-tissue infections in ambulatory pediatrics. Antibiotic treatment recommendations suggest incorporating local epidemiology for the prevalence of CA-MRSA. We sought to identify the antibiotic strategy with the highest probability of activity and to identify threshold values for epidemiologic variables including bacterial prevalence and antibiotic resistance.Methods: We used decision analysis to evaluate 3 empiric antibiotic strategies: clindamycin, trimethoprim/sulfamethoxazole (T/S), and cephalexin. We calculated the probability of activity against the bacteria causing the infection (CA-MRSA, methicillin-sensitive S. aureus and group A Streptococcus [GAS]) ...

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  Expert Reviews Treatment Options for CA-MRSA

SAN DIEGO — Clindamycin and trimethoprim-sulfamethoxazole are the most commonly used agents to treat community-acquired methicillin-resistant Staphylococcus aureus on an outpatient basis, but neither is perfect, according to one expert (Source: Pediatric News)

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  Characterization of antimicrobial resistance patterns and integrons in human fecal Escherichia coli in Taiwan.

Authors: Yang CM, Lin MF, Lin CH, Huang YT, Hsu CT, Liou ML Two hundred and twenty-five fecal strains of Escherichia coli isolated from 109 non-hospitalized adults in 2006 were investigated for susceptibility to antibiotics and for the presence of integrons. High resistance rates in fecal strains of E. coli were observed for streptomycin (52.0%), ampicillin (50.2%), piperacillin (50.2%), trimethoprim/sulfamethoxazole (47.6%) and chloramphenicol (33.8%). Integrons were found in 31.5% (71/225) of the strains using an integrase gene PCR assay. Among 71 integrase-positive strains, 65 strains belonged to class 1 integrons, while the remainder belonged to class 2. Gene cassette patterns of class 1 integrons were further characterized by PCR and direct sequencing. Among those class 1 integras...

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  Emergence of Fluoroquinolone Resistance in Outpatient Urinary Escherichia coli Isolates: Johnson L, Sabel A, Burman WJ, et al. Am J Med 2008;121:876–84

In 1999, due to high trimethoprim-sulfamethoxazole (TMP-SMX) resistance rates in Escherichia coli (E. coli), Denver Health decided to use levofloxacin as the initial therapy for urinary tract infections (UTIs). This retrospective case-control study was performed on a subset of patients with urine cultures positive for E. coli during 2005, and evaluated the effects of that switch 6 years later. Levofloxacin prescriptions per 1000 outpatient visits and levofloxacin resistance in outpatient E. coli were evaluated over time. E. coli isolated in 2005 were further characterized by specimen source and antimicrobial susceptibilities. Risk factors for levofloxacin-resistant E. coli UTI among non-pregnant adult outpatients were evaluated. Between 1998 and 2005, levofloxacin use increased from 3.1 to...

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  Trimethoprim/Sulfamethoxazole Resistance in Urinary Tract Infections

Abstract: Urinary tract infections (UTI) are among the most prevalent infectious diseases, and their financial burden on society is substantial. Management of UTIs has been complicated by the emergence of resistance to most commonly used antibiotics. Increasing prevalence of resistance has led to a gradual evolution in the antibiotics used to treat UTIs. The aims of this study were to determine the TMP/SMX (trimethoprim/sulfamethoxazole) resistance rate in patients with uncomplicated UTIs and to determine which empiric antibiotics are prescribed in the emergency department for the outpatient management of UTI. Between June 2004 and May 2005, archives of the emergency department were searched retrospectively and the files of patients diagnosed with UTI were reviewed. Patients' demographical...

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  Pneumocystis Pneumonia: Current Concepts in Pathogenesis, Diagnosis, and Treatment

Pneumocystis pneumonia (PCP) is an infection of the lungs caused by the opportunistic fungal genus Pneumocystis. In humans, PCP is a serious and potentially life-threatening infection occurring in immunocompromised individuals, particularly those who have AIDS, or following immune suppression from malignancy, organ transplantation, or therapies for inflammatory diseases. Several recent studies have contributed to understanding of the biology and pathogenesis of the organism yielding new diagnostic approaches and therapeutic targets. Although trimethoprim-sulfamethoxazole remains the mainstay of prophylaxis and treatment, ongoing concerns for emerging Pneumocystis resistance supports the continuing investigation for novel therapeutic agents. (Source: Clinics in Chest Medicine)

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  Characterisation of a Staphylococcus aureus strain with progressive loss of susceptibility to vancomycin and daptomycin during therapy

Abstract: Following an initial response to vancomycin therapy, a patient with meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia developed endocarditis, failed a second course of vancomycin and then failed daptomycin therapy. An increase in the vancomycin minimum inhibitory concentrations of four consecutive MRSA blood isolates from 2μg/mL to 8μg/mL was shown by Etest. Population analysis of four successive blood culture isolates recovered over the 10-week period showed that the MRSA strain became progressively less susceptible to both vancomycin and daptomycin. Retrospectively, the macro Etest method using teicoplanin indicated a decrease in vancomycin susceptibility in the second blood isolate. The patient improved after treatment with various courses of trimethoprim/sulfame...

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  Prevalence of Virulence Factors and Antimicrobial Resistance of Uropathogenic Escherichia coli in Jiangsu Province (China)

Conclusions: In Jiangsu province, the problem of antibiotic resistance for uropathogenic E. coli is rather serious and empiric treatment of urinary tract infections with all the antibiotics we tested is no longer appropriate. Cefotaxime-, cefoxitin-, chloramphenicol-, and nitrofurantoin-resistant isolates have a reduced virulence factor genes compared with susceptible strains. (Source: Urology)

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  A First Case of Trimethoprim-Sulfamethoxazole Induced Sweet's Syndrome in a Child

(Source: Pediatric Dermatology)

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  Effect of long-term trimethoprim/sulfamethoxazole treatment on resistance and integron prevalence in the intestinal flora: a randomized, double-blind, placebo-controlled trial in children

Conclusions Initially, trimethoprim/sulfamethoxazole usage was strongly associated with the appearance of integron-positive (multi)drug-resistant Enterobacteriaceae in the intestinal flora. After prolonged exposure to trimethoprim/sulfamethoxazole, however, this population of Enterobacteriaceae was substituted by a population with non-integron-associated resistance mechanisms. After trimethoprim/sulfamethoxazole was discontinued, susceptibility rates to all antibiotics returned to baseline levels. (Source: Journal of Antimicrobial Chemotherapy)

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  Resistance to trimethoprim/sulfamethoxazole and Tropheryma whipplei

Abstract: Whipple's disease (WD) is a chronic infection caused by Tropheryma whipplei. A 1-year treatment of oral trimethoprim/sulfamethoxazole (SXT) is commonly used. Advances in the culture of T. whipplei have allowed for full genome sequencing and antibiotic susceptibility testing, which has demonstrated resistance of T. whipplei to trimethoprim. Several mutations in the folP gene that encodes dihydropteroate synthase, the target of sulphonamides, has been reported for one patient with clinically acquired resistance to SXT. Here we report three new patients who experienced clinically acquired resistance to SXT during treatment and one patient with biological failure. Sixty-two folP sequences from DNA samples of 59 WD patients were also obtained. Among the detected amino acid changes, tw...

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  Resistance to trimethoprim/sulfamethoxazole and Tropheryma whipplei.

Authors: Fenollar F, Rolain JM, Alric L, Papo T, Chauveheid MP, van de Beek D, Raoult D Whipple's disease (WD) is a chronic infection caused by Tropheryma whipplei. A 1-year treatment of oral trimethoprim/sulfamethoxazole (SXT) is commonly used. Advances in the culture of T. whipplei have allowed for full genome sequencing and antibiotic susceptibility testing, which has demonstrated resistance of T. whipplei to trimethoprim. Several mutations in the folP gene that encodes dihydropteroate synthase, the target of sulphonamides, has been reported for one patient with clinically acquired resistance to SXT. Here we report three new patients who experienced clinically acquired resistance to SXT during treatment and one patient with biological failure. Sixty-two folP sequences from DNA sampl...

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  Tips to Avoid Inducing Resistance in CA-MRSA

SAN DIEGO — Clindamycin and trimethoprim-sulfamethoxazole are the most commonly used agents to treat community-acquired methicillin-resistant Staphylococcus aureus on an outpatient basis, but neither is perfect, according to one expert. (Source: Family Practice News)

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  A case of Noonan syndrome and Whipple's disease in the same patient.

We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient. A 36-year-old female with history of Noonan syndrome developed fatigue, anorexia, arthritis of the knees and hands with a diffuse hyperpigmented rash, night sweats, and an unintentional fifteen pound weight loss over 4 mo. Small bowel enteroscopy demonstrated mild edematous yellowish mucosa without friability. Random small bowel biopsies revealed extensive periodic acid-Schiff positive material within the foamy macrophages. She was treated with a 12 mo course of trimethoprim-sulfamethoxazole DS with clinical improvement to baseline status. PMID: 19322929 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

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  Long-term transduction of miniature pig parotid glands using serotype 2 adeno-associated viral vectors

Previously, using an adenoviral vector, we showed that miniature pigs could provide a valuable and affordable large animal model for pre-clinical gene therapy studies to correct parotid gland radiation damage. However, adenoviral vectors lead to short-term transgene expression and, ideally, a more stable correction is required. In the present study, we examined the suitability of using a serotype 2 adeno-associated viral (AAV2) vector to mediate more stable gene transfer in the parotid glands of these animals.Heparan sulfate proteoglycan was detected by immunohistochemistry. [beta]-galactosidase expression was determined histochemically. An AAV2 vector encoding human erythropoietin (hEpo) was administered via Stensen's duct. Salivary and serum hEpo levels were measured using an enzyme-link...

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  Trimethoprim-Sulfamethoxazole Exposure Alters Ex Vivo Function of B Lymphocytes Isolated from Human Immunodeficiency Virus-Infected Patients Receiving Zidovudine

Conclusion. Although these data were affected by limitations in power and study design, they suggest that peripheral B-lymphocyte function is altered as a result of TMP-SMX exposure in HIV-infected patients concurrently receiving zidovudine. Further study of this effect is warranted. (Source: Pharmacotherapy: Official Journal of the American College of Clinical Pharmacy)

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  SULFATRIM (Sulfamethoxazole And Trimethoprim) Suspension [Actavis Mid Atlantic LLC]

Updated Date: Mar 19, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Molecular epidemiology and antimicrobial susceptibility of extended- and broad-spectrum beta-lactamase-producing Klebsiella pneumoniae isolated in Portugal.

Authors: Mendonça N, Ferreira E, Louro D, , Caniça M All 187 Klebsiella pneumoniae isolated over six consecutive months of 1999 in 17 Portuguese health institutions were studied: 89% were resistant to ampicillin, 31% to trimethoprim/sulfamethoxazole, 17% to aminoglycosides and 3% to fluoroquinolones; 16% were multidrug-resistant and 14% expressed an extended-spectrum beta-lactamase (ESBL) phenotype confirmed by genotyping. Molecular methods identified: 11 isolates possessing bla(ESBL-SHV) genes (bla(SHV-2A), bla(SHV-5), bla(SHV-12) and bla(SHV-55)), 9 isolates with bla(ESBL-TEM) (bla(TEM-3), bla(TEM-10) and bla(TEM-24)) and 7 isolates with bla(GES-1), encoding ESBL enzymes; and 160 isolates with bla(SHV-1) and bla(SHV-type) encoding non-ESBL enzymes. Overall, 15 new beta-lact...

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  New Plasmid-Mediated Quinolone Resistance Gene, qnrC, Found in a Clinical Isolate of Proteus mirabilis.

Authors: Wang M, Guo Q, Xu X, Wang X, Ye X, Wu S, Hooper DC, Wang M Since the discovery of qnrA in 1998 two additional qnr genes, qnrB and qnrS, have been described. These three plasmid-mediated genes contribute to quinolone resistance in gram-negative pathogens worldwide. A clinical strain of Proteus mirabilis was isolated from an outpatient with urinary tract infection that was susceptible to most antimicrobials, but resistant to ampicillin, sulfamethoxazole and trimethoprim. Plasmid pHS10 harbored by this strain was transferred to azide-resistant E. coli J53 by conjugation. A transconjugant with pHS10 had low-level quinolone resistance but was negative by PCR for the known qnr genes, aac(6')-Ib-cr and qepA. Ciprofloxacin MICs for the clinical strain and a J53 pHS10 transconjugant we...

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  Orbital abscess bacterial isolates and in vitro antimicrobial susceptibility patterns in dogs and cats.

CONCLUSIONS: Mixed aerobic and anaerobic bacterial infections of the orbit occur commonly in dogs and cats. On the basis of aerobic and anaerobic bacterial isolates and in vitro susceptibility testing of aerobic bacterial isolates, cephalosporins, extended-spectrum penicillins, potentiated-penicillins and carbapenems are recommended for initial antimicrobial therapy of orbital abscess in dogs and cats. PMID: 19261163 [PubMed - in process] (Source: Veterinary Ophthalmology)

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  Achromobacter xylosoxidans, an emerging pathogen in catheter-related infection in dialysis population causing prosthetic valve endocarditis: a case report and review of literature.

Conclusion: AX is an emerging pathogen in catheter-related infection in the dialysis population and, therefore, needs vigilance and prompt treatment. Antimicrobial treatment should include susceptibility and synergy testing. Removal of central intravenous catheter should also be considered at the time of early presentation in patients at high risks of developing infective endocarditis. PMID: 19281752 [PubMed - in process] (Source: Clinical Nephrology)

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  Cranial unifocal Langerhans cell histiocytosis in children

Conclusions: We conclude that EG is a benign disease. At the time of diagnosis, a bone scan should be performed to rule out a multifocal disease. Surgical resection is the treatment of choice. Nevertheless, for lesions in which excision can cause cosmetic defects, administration of sulfamethoxazole and trimethoprim after biopsy appeared to be an effective alternative treatment. (Source: Journal of Pediatric Surgery)

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  Antibiotic resistance in Staphylococcus aureus-containing cutaneous abscesses of patients with HIV.

CONCLUSIONS: Empiric antimicrobial therapy of HIV-infected persons with cutaneous abscesses must be tailored to the high frequency of antimicrobial drug resistance including MRSA in this population. PMID: 19328381 [PubMed - in process] (Source: The American Journal of Emergency Medicine)

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  Antibiotic resistance in Staphylococcus aureus–containing cutaneous abscesses of patients with HIV

Conclusions: Empiric antimicrobial therapy of HIV-infected persons with cutaneous abscesses must be tailored to the high frequency of antimicrobial drug resistance including MRSA in this population. (Source: The American Journal of Emergency Medicine)

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  National Trends in Emergency Department Antibiotic Prescribing for Elders with Urinary Tract Infection, 1996-2005.

Conclusions: From 1996 to 2005, TMP-SMX monotherapy in elder ED patients decreased while fluoroquinolone therapy increased. The majority of older patients receiving fluoroquinolone therapy received a single agent. Given the continued prevalence of monotherapy for elder ED patients with UTI or pyelonephritis, antibiotic resistance patterns in these patients should be better characterized to ensure institution of appropriate empiric therapy. ACADEMIC EMERGENCY MEDICINE 2009; 16:1-8 (c) 2009 by the Society for Academic Emergency Medicine. PMID: 19245373 [PubMed - as supplied by publisher] (Source: Academic Emergency Medicine)

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  A role for carbapenem in the treatment of melioidosis in developing countries?

We report a case of persistent septicemic melioidosis that failed to respond to ceftazidime plus TMP-SMX, but subsequently gave a clinical response to meropenem and surgical debridement. (Source: International Journal of Infectious Diseases)

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Top Viagra Store

A first shop in the series of one-pill shops is rightfully viagra-targeted. The index page offers only Viagra, both generic and original.It is possible to purchase other ED products from other pagers, but the main accent is on Viagra.

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Indian Meds

A most recent indian-themed, ethnic site. Includes generic and original (brand) products. al our standard navigational tools and support options are available. This site converts nicely on general pharmaceutical traffic as it has products for vurtually any need.

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Friendly ED Pharmacy

Many ED customers are anxious about the status their orders. This special friendly site is here to solve the problem. "State of the art" design features high usability and clearly visible support options. All this helps to satisfy even the most demanding customer and results in increased sales ratio.

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Popular ED Products

This ED site offers simplistic design that gets right to the point - this IS the site for ED. Popular ED list the top selling products and converts best on ED-targeted, pill-specific traffic.

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Perfect ED Store

This site is just right for ED customers. All ED products are conveniently listed at main page, allowing to make an easy choice. Our regular Sample Pills Offer is emphasized here. Customers can try new products and are likely to return for more refills.

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Worlds Best Pharmacy

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Delhi Drugs

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www.delhi-drugs.com

Indian Generics

Many customers are looking for Indian drugs, and this site is designed specifically for such customers. It includes many generic products, modern design, translated into 7 languages and prices in both USD and Euros. Also it uses our latest shopping engine and billing page.

www.indian-generics.com