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Cotrimoxazole was the most common cause of FDE, whereas FDE with diclofenac sodium, pyrantel pamoate, clindamycin, and albendazole were reported for the first time. FDE may have multiform presentations.
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The addition of a calcium channel blocking agent, steroids, antibiotics, and more acetaminophen effected a higher stone passage rate and fewer lost work days, emergency room visits, and surgical interventions.
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Of the 6 reported cases, 5 related bacterial keratitis and 2 scleritis. (One case reported S. maltophilia keratitis and secondary scleritis.) The primary risk factor in such cases is ocular surgery. The organism cultured was the single isolate in three cases (50%). The susceptibility test showed that 50%, 83%, and 100% of the isolates were sensitive to ceftazidime, a combination of trimethoprim and sulfamethoxazole, and ciprofloxacin respectively.
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Twenty-four patients with eruptions induced by sulfonamide-related drugs were studied to detect lymphocyte reactivity to drugs. Both the lymphocyte transformation test and limiting dilution analysis were used as assays for drug-reactive lymphocytes. Peripheral blood lymphocytes were expanded in interleukin-2 and tested for reactivity to sulfamethoxazole and furosemide.
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We assessed the impact of distributing an outpatient age-specific methicillin-resistant Staphylococcus aureus (MRSA) antibiogram on physician knowledge of MRSA prevalence and choice of empiric therapy. Questionnaires were given to 125 physicians at outpatient pediatric clinics in Monroe County, NY, before and after antibiogram distribution (response rates, 42% and 24%, respectively). The median physician-estimated MRSA prevalence (among S. aureus skin infections) was 15% before they received the antibiogram and 20% after. According to the antibiogram, the true 2005 prevalence was 25% among skin infections. When asked to select empiric therapy for a pediatric outpatient with a skin abscess, while assuming varying levels of MRSA prevalence, most selected cephalexin when the prevalence was assumed to be 20% or less, and trimethoprim-sulfamethoxazole when the prevalence was assumed to be 30% or greater. These data suggest that antibiograms may improve empiric therapy decision making by increasing knowledge of local outpatient prevalence of antibiotic resistance.
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A total of 31 girls had experienced sixty-four UTIs during three hundred sixty-seven months (17.4 UTIs/100 patient-months) while receiving TMP/SMZ and/or NFN as single-drug prophylaxis. Of the girls, 21 (68%) had reflux, 15 (49%) had detrusor instability/voiding dysfunction, 8 (26%) had both reflux and voiding dysfunction, and 3 (10%) had neither voiding dysfunction nor reflux. While receiving double antimicrobial prophylaxis, 8 girls (26%) experienced a UTI and only 3 (10%) showed a UTI resistant to both TMP/SMZ and NFN. There were only sixteen breakthrough UTIs during four hundred thirty-nine months of double prophylaxis (3.6 UTIs/100 patient-months) (P < 0.001).
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In 33 consecutive AIDS patients with a first episode of Pneumocystis carinii pneumonia (PCP) we evaluated treatment, outcome, recurrence rate and pyrimethamine as chemoprophylaxis in a 1-year follow-up. Only 2 patients had a CD4 lymphocyte cell count greater than 0.2 X 10(9)/l. Trimethoprim-sulfamethoxazole (TMP-SMX) was initially given to 32 patients but in 20 of these patients severe adverse reactions caused us to discontinue treatment. Of these 20 patients 11 were started on i.v./i.m. pentamidine but in 6 adverse reactions forced us to withdraw pentamidine. Patients were retrospectively divided with regard to duration of therapy into 2 groups. We could not find any difference between patients in Group 1 treated for less than or equal to 14 days and patients in Group 2 treated for greater than 14 days when comparing outcome, number of recurrences and mean time until recurrence. In 16/21 patients given only TMP-SMX initially in a high dose (means = 16 mg trimethoprim/kg/day), dose reduction was performed to means = 10.5 mg trimethoprim/kg/day after a mean time of 6.9 days. The case-fatality rate for these patients was 10% (2/21) and the overall case-fatality rate was 15% (5/33). We chose pyrimethamine (50-175 mg/week) as secondary prophylaxis for PCP. At 1-year follow-up another 16 patients had died (21/32) and 9/27 (33%) discharged patients had had one recurrence each of PCP. All recurrences occurred among patients treated with only TMP-SMX for the acute episode of PCP. Of these 27 discharged patients 23 had been given pyrimethamine and 8 (36%) of these had experienced a recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
Group B streptococcus (GBS) is the major cause of bacterial sepsis and meningitis in neonates and poses a significant threat to parturient women. Recently, we identified in GBS the polypeptide PcsB, which is a protein required for cell separation of GBS, and which is also involved in the antibiotic sensitivity of these bacteria. In the present study, the introduction of the pcsB-carrying plasmid pATpcsB into the PcsB-deficient GBS mutant Sep1 restored the phenotype and the antibiotic susceptibility of this strain to that of the GBS wild-type. Although Northern blots revealed a four- to five-fold increased transcription of pcsB in pATpcsB-carrying GBS strains, overexpression of pcsB did not result in higher amounts of PcsB in the cell wall and in the culture supernatant of GBS, indicating regulatory mechanisms that control the translation or secretion of PcsB in these bacteria. In the culture supernatant of mutant Sep1 significant amounts of enolase were identified. As this protein was also present in extracts of cell wall-bound proteins from the GBS wild-type, it can be speculated that GBS can translocate enolase across the cytoplasmic membrane. Northern blot analysis exhibited similar expression of the enolase gene in the GBS strains 6313 and Sep1, indicating that mutant Sep1 is impaired in the anchoring of this protein to its cell wall.