J Heart Lung Transplant, 2005 Jan, 24(1), 34 - 7 Acceptable recipient outcomes with the use of hearts from donors with hepatitis-B core antibodies; Pinney SP et al.; BACKGROUND: The shortage of available donors limits cardiac transplantation . Use of hearts from patients with hepatitis-B core antibodies could expand the donor pool but are usually avoided because of concern about virus transmission . We conducted a retrospective review to determine the safety of transplanting hearts from donors with hepatitis-B core antibodies . METHODS: We reviewed donor and recipient charts for patients who underwent transplantation at our center between January 1, 1997, and December 1, 2002 . RESULTS: A total of 541 heart transplantations were performed in this time period . Thirty-three patients (aged 47.5 +/- 18.8 years) received hearts from core-antibody-positive donors (aged 37.7 +/- 10.8 years) . Of these, 5 patients received prophylactic antibiotic treatment with lamivudine after transplantation . Only 1 patient (baseline surface-antigen-negative and without prophylaxis) experienced donor-transmitted hepatitis B infection 10 months after transplantation that was treated with lamivudine . Two patients (baseline surface-antibody-negative) had hepatitis B seroconversion, becoming surface-antibody positive without evidence of infection . None of the 5 patients who received prophylaxis with lamivudine had donor-transmitted hepatitis, and only 1 lamivudine-treated patient had surface antibodies . Post-transplant survival in this small cohort was similar to that for all patients who underwent transplantation at our center during this time period . CONCLUSIONS: Transplantation of hearts from donors with hepatitis-B core antibodies is associated with a small viral-transmission risk, with or without post-transplant, anti-viral prophylaxis . Use of these donor hearts should be considered safe and may help to augment the available donor pool. Clin Chim Acta, 2005 Feb, 352(1-2), 209 - 15 Excessive matrix metalloproteinase-9 in the plasma of community-acquired pneumonia; Yang SF et al.; BACKGROUND: It has been shown that matrix metalloproteinase-9 (MMP-9) is involved in the pathogenesis of various pulmonary inflammatory diseases . We determined the MMP-9 concentration in the plasma of community-acquired pneumonia (CAP) patients before and after antibiotic treatment . METHODS: Gelatin zymography and ELISA analysis were used to measure MMP-9 activity and MMP-9 level, respectively, in 35 control subjects and 46 CAP patients . RESULTS: WBC counts, neutrophils, MMP-9 activity and MMP-9 level were significantly higher in CAP patients compared with that of control subjects (P<0.001), while MMP-9 activity and MMP-9 level were returned to normal after the antibiotic treatment (P<0.001) . In addition, MMP-9 level correlated positively with WBC counts and neutrophils number both before and after the antibiotic treatment . CONCLUSIONS: MMP-9 may play an important role in the pathogenesis of CAP with a positive correlation with the number of neutrophils. J Microbiol, 2004 Dec, 42(4), 305 - 14 Axenic culture of Gyrodinium impudicum strain KG03, a marine red-tide microalga that produces exopolysaccharide; Yim JH et al.; An exopolysaccharide-producing microalgal dinoflagellate was isolated from a red-tide bloom and designated strain KG03 . A bacteria-free culture of strain KG03 was achieved using a modified wash with phototaxis and antibiotic treatment . Combined treatment with neomycin and cephalosporin was the most effective for eliminating the bacteria associated with the microalgae . Strain KG03 was identified as Gyrodinium impudicum by analyzing the ITS regions of the 5.8S rDNA, 18S rDNA, morphological phenotype and fatty acid composition . The exopolysaccharide production and cell growth in a 300-ml photobioreactor were increased 2.7- and 2.4-fold, respectively, compared with that in a flask culture at the first isolation step. Vnitr Lek, 2004 Nov, 50(11), 830 - 5 {Factors participating in development of bleeding varices in portal hypertension . Part I: bacterial infection and comparison of intravenous and peroral antibiotics effects--a randomised study}; Lata J et al.; An acute bleeding from oesophageal varices as a result of portal hypertension is a frequent and at the same time serious complication of cirrhosis of the liver . One of factors influencing this bleeding can be a bacterial infection . Endotoxines can increase portal pressure and so participate in development of bleeding and simultaneously deteriorate a patient's prognosis . An antibiotic treatment is a part of a treatment algorithm, however what antibiotics to administer and in what manner is unclear . A group of 46 patients who were admitted to a hospital for an acute bleeding from varices has been compared in the study to 48 cirrhosis patients hospitalised for other reasons . An infection incidence was high in both groups (63.0 % vs . 54.2 %), bleeding patients had more often positive hemoculture (17.3 % vs . 8.6 %), and statistically significantly more often positive findings in throat swab culture (36.9 % vs . 17.3 %, p = 0.04) which is an evidence of an increased pathology colonisation of these patients . Bleeding patients were randomised for peroral norfloxacin administration (n = 25) or an intravenous administration of a combination of ampicilin and sulbactam (n = 21) . There was no difference in survival of both groups . Due to a high number of bacterial infections antibiotics administration has been indicated in these patients . Intravenous administration is probably of the same effect as peroral administration. J Burn Care Rehabil, 2005 Jan-Feb, 26(1), 57 - 61 Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns; Wahl WL et al.; Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality for patients with burns . In nonburn populations, bronchoalveolar lavage (BAL) excludes other pathology such as systemic inflammatory response syndrome . We hypothesized that BAL would decrease our false-positive VAP rate . All ventilated patients with burn injury who were admitted to our institution from July 2000 through June 2003 were included . After June 2001, BAL was used to make the diagnosis of VAP, with >/=10 organisms considered a positive result . Fifty patients met criteria for VAP, 21 in the pre-BAL period and 29 in the BAL period . Six patients (21%) in the BAL group had quantitative cultures <10 and were not treated . The outcomes for these patients were not different than those treated for VAP . There were no differences in age, TBSA size, antibiotic use, or ventilator days for the pre-BAL or BAL groups, although the pneumonia rate was lower for the BAL time period . The use of BAL eliminated the unnecessary antibiotic treatment of 21% of patients in the BAL time period and was associated with a lower rate of VAP. Comput Methods Programs Biomed, 2005 Jan, 77(1), 23 - 37 A diagnostic reasoning and optimal treatment model for bacterial infections with fuzzy information; Kao HY et al.; This study proposes an optimization model for optimal treatment of bacterial infections . Using an influence diagram as the knowledge and decision model, we can conduct two kinds of reasoning simultaneously: diagnostic reasoning and treatment planning . The input information of the reasoning system are conditional probability distributions of the network model, the costs of the candidate antibiotic treatments, the expected effects of the treatments, and extra constraints regarding belief propagation . Since the prevalence of the pathogens and infections are determined by many site-by-site factors, which are not compliant with conventional approaches for approximate reasoning, we introduce fuzzy information . The output results of the reasoning model are the likelihood of a bacterial infection, the most likely pathogen(s), the suggestion of optimal treatment, the gain of life expectancy for the patient related to the optimal treatment, the probability of coverage associated with the antibiotic treatment, and the cost-effect analysis of the treatment prescribed. BJU Int, 2005 Jan, 95(1), 117 - 9 Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms; Johnson CW et al.; OBJECTIVES To report our experience with transurethral resection of the ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction (EDO) . PATIENTS AND METHODS We retrospectively reviewed the operative cases of one urologist from 1995 to 2001, identifying 15 patients with symptomatic EDO who underwent TURED . These men had normal hormone levels and no other known genitourinary dysfunction . Investigations included a history, physical examination, semen analysis, semen culture, and high-resolution transrectal ultrasonography . Responses to focused questions and semen analysis were evaluated after surgery . RESULTS Before surgery, all patients complained of a decrease in the volume of their ejaculate, 14 of 15 had a non-projectile ejaculation, nine had a genitourinary infection necessitating antibiotic treatment, and five had pain with orgasm . The mean ejaculate volume and total motile sperm count was 1.1 mL and 8.1 million sperm per ejaculate . After surgery, at a mean follow-up of 2 months, 10 men reported having projectile ejaculation, and eight reported a marked improvement in their sensation of orgasm . Overall, 14 men reported a subjective improvement in their ejaculation . The average postoperative ejaculate volume was 2.3 mL and the total motile sperm count was 38.1 million per ejaculate . CONCLUSIONS Men with symptomatic EDO who underwent TURED showed improvements in their ejaculation, sensation of orgasm, semen analysis values and fertility. Ned Tijdschr Geneeskd, 2004 Dec 11, 148(50), 2496 - 500 {Leukocyte-adhesion deficiency: a rare disorder of inflammation}; van Vliet DN et al.; In a 6-week-old male infant who was referred because of an umbilical hernia and a non-purulent omphalitis, type-I leukocyte-adhesion deficiency was diagnosed . Additional clues were persisting leukocytosis upon clinical improvement under antibiotic treatment and a late falling off of the umbilical remnant in the patient's history . After cure by antibiotic therapy, life-long antibiotic prophylaxis was prescribed . Leukocyte-adhesion deficiency syndromes are rare, autosomal recessive, hereditary immunological disorders . The basis of these disorders is found in the absence or defective function of adhesion molecules that are needed for an interaction between the leukocytes, especially neutrophilic granulocytes, and endothelial surfaces . On the basis of clinical signs and symptoms and laboratory findings, two types of leukocyte-adhesion deficiency can be distinguished . Type I is marked by a disorder in the migration of granulocytes through the endothelium, in which integrins are involved . In type II, there is a disorder in the first step in the adhesion of granulocytes to the endothelium, in which selectins are involved . These conditions already become manifest in childhood . Therapy is generally symptomatic and consists mainly of the prevention and treatment of infection . Cure is sometimes possible by means of allogenic bone-marrow transplantation. Immunobiology, 2004, 209(8), 599 - 608 Toll-like receptors 2 and 4 do not contribute to clearance of Chlamydophila pneumoniae in mice, but are necessary for the release of monokines; Mueller M et al.; Activation of immune cells by Chlamydophila pneumoniae in vitro has been shown to be toll-like receptor (TLR2)-dependent, but TLR4 is also involved to a minor extent . To investigate the role of TLR2 and TLR4 in vivo, a murine model of C . pneumoniae infection was established . Mice were infected intranasally with a low inoculum of 106 C . pneumoniae elementary bodies (EB) and spreading of bacteria was monitored by real-time PCR . The bronchoalveolar lavage (BAL) showed maximal bacterial load on the day of infection and the lung 2 days later . By day 95, C . pneumoniae were eradicated completely . In serum, anti-C . pneumoniae IgG became detectable on day 18 by microimmunofluorescence test . The course of infection was mild with no apparent symptoms, lack of acute phase response and no induction of tumor necrosis factor-alpha and interleukin-6 in BAL, lung supernatants or blood . Infection of TLR2-/- and C3H/HeJ mice revealed no differences in clearance of bacteria and serological responses compared to wild-type controls, even if a dose of 10(7) EB was used . Intracellular replication of C . pneumoniae in the lungs was proven by the efficacy of antibiotic treatment . These findings indicate that in vivo TLR2 and TLR4 are not important for the development of antibodies and elimination of C . pneumoniae. Coll Antropol, 2004 Jun, 28(1), 325 - 9 Common bile duct obstruction caused by the hydatid daughter cysts; Busic Z et al.; Echinococcosis is a human parasitary disease . In 2002, 29 new cases of liver echinococcosis were recorded in Croatia . Liver is the most common site of hydatid cysts . Nine patients with echinoccocal liver disease were operated in our department in 2002 . Here we present a case where a patient with verified hydatid cyst in the left liver lobe developed high fever, jaundice, nausea, vomiting and pain in the upper abdomen . The symptoms were initially ascribed to the acute cholangitis . After unsuccessful antibiotic treatment, computerized tomography and endoscopic retrograde cholangiopancreatography (ERCP) were performed, demonstrating daughter cysts in the common bile duct . During ERCP, papilotomy was made and daughter cysts were extracted . Hydatid cyst was surgically removed, and a communication between the cyst and left hepatic duct was noted during surgery . Pericystectomy, choledochotomy, removal of remaining daughter cysts from the common bile duct, and sutures of left hepatic duct were performed . The patient recovered fully after the surgery . One of the possible complications of the liver hydatid cysts is the communication between cyst and the biliary tree . Such communications are usually asymptomatic, but symptoms can also mimic acute cholangitis and jaundice, which may lead to the misdiagnosis of the patient's condition. Pediatr Surg Int . 2005 Jan 6; {Epub ahead of print} Malakoplakia of bladder in childhood; Shah A et al.; Malakoplakia is a granulomatous inflammatory disease affecting the genitourinary tract . It is rare in childhood . We report a case of malakoplakia presenting as multiple bladder polyps in an 11-year-old boy . The child did not respond to long-term antibiotic treatment, and subsequent surgical excision of the polyps resolved his problems . We propose surgical excision as an alternative form of management of this rare lesion. J Infect Dis, 2005 Feb 1, 191(Suppl 1), S168 - 78 Determinants of the Impact of Sexually Transmitted Infection Treatment on Prevention of HIV Infection: A Synthesis of Evidence from the Mwanza, Rakai, and Masaka Intervention Trials; Korenromp EL et al.; Community-randomized trials in Mwanza, Tanzania, and Rakai and Masaka, Uganda, suggested that population characteristics were an important determinant of the impact of sexually transmitted infection (STI) treatment interventions on incidence of human immunodeficiency virus (HIV) infection . We performed simulation modeling of HIV and STI transmission, which confirmed that the low trial impact in Rakai and Masaka could be explained by low prevalences of curable STI resulting from lower-risk sexual behavior in Uganda . The mature HIV epidemics in Uganda, with most HIV transmission occurring outside core groups with high STI rates, also contributed to the low impact on HIV incidence . Simulated impact on HIV was much greater in Mwanza, although the observed impact was larger than predicted from STI reductions, suggesting that random error also may have played some role . Of proposed alternative explanations, increasing herpetic ulceration due to HIV-related immunosuppression contributed little to the diminishing impact of antibiotic treatment during the Ugandan epidemics . The strategy of STI treatment also was unimportant, since syndromic treatment and annual mass treatment showed similar effectiveness in simulations of each trial population . In conclusion, lower-risk behavior and the mature HIV epidemic explain the limited impact of STI treatment on HIV incidence in Uganda in the 1990s . In populations with high-risk sexual behavior and high STI rates, STIs treatment interventions may contribute substantially to prevention of HIV infection. Invest Ophthalmol Vis Sci, 2005 Jan, 46(1), 83 - 7 Mass Treatment and the Effect on the Load of Chlamydia trachomatis Infection in a Trachoma-Hyperendemic Community; West ES et al.; PURPOSE: Trachoma remains a leading cause of blindness . Determining the most effective antibiotic treatment strategy is essential for the success of country-based trachoma control programs . METHODS: Baseline and 2-month follow-up examinations were performed in a trachoma-hyperendemic village . All residents were offered azithromycin for trachoma after baseline was determined . Infection with Chlamydia trachomatis and chlamydial load were determined by PCR . Clinical trachoma status was evaluated . A high chlamydial load was defined as a higher than median chlamydial load among those with infection . Risk factors were examined in multiple logistic regression models . Associations are presented as odds ratios and 95% confidence intervals . RESULTS: At baseline, 57% of participants were infected with C . trachomatis . Although clinical trachoma correlated with infection, 23% of participants with high chlamydial loads showed no clinical signs . Adults represented only 10% of the population with high loads . Treatment significantly decreased the proportion positive in the community and the load in the community . However, 27% of individuals with high loads at baseline who received treatment also were infected at 2 months . Of those, 93% with high loads at 2 months were aged </=10 years . CONCLUSIONS: Although most of the chlamydial load in this community resided in children, 10% of the high load resided in adults, most of whom did not have follicular trachoma and in whom the infection would be missed under treatment strategies that focus on clinical disease or children . These data support a mass treatment strategy for hyperendemic communities, at least as a first approach . In addition, treatment of children age </=2 years should be reexamined, as >30% with high loads at baseline remained infected at 2 months, despite monitored treatment according to weight. Br Poult Sci, 2004 Oct, 45(5), 684 - 94 Effects of mushroom and herb polysaccharides, as alternatives for an antibiotic, on growth performance of broilers; Guo FC et al.; (1) This in vivo trial was conducted to study the effects of polysaccharide extracts of two mushrooms, Lentinus edodes (LenE) and Tremella fuciformis (TreE), and a herb, Astragalus membranaceus (AstE) on growth performance, and the weights of organs and the gastrointestinal tract (GIT) of broiler chickens . (2) Three extracts (LenE, TreE and AstE) were supplemented at inclusion rates of 0.5, 1, 2, 3 and 4 g/kg from 7 to 14 d of age and compared with an antibiotic treatment group (20 mg/kg, virginiamycin (VRG) as well as a group of non-supplemented birds . (3) Body weight (BW) gain, feed intake and feed conversion ratio (FCR) of the extract-supplemented groups were not significantly different from those of the antibiotic group . Significant effects of type of extract and concentration on growth performance were found from 7 to 28 d of age . Generally, birds fed with LenE showed higher BW gain and lower FCR from 7 to 28 d of age than those fed with TreE and AstE and 2 g/kg LenE was considered the optimal inclusion rate for enhanced broiler growth . However, the extracts had no significant effect on the relative weights of organs and GIT compared with the antibiotic group . (4) The birds fed the extracts showed better growth performance than the non-supplemented birds, but were not significantly different from those fed VRG . Of the three extracts, LenE appeared to be a potential growth promoter . Future studies are needed to investigate whether the extracts can be used as alternatives for antibiotic growth promoters in challenged birds, and to elucidate the mechanisms for potentially enhanced growth performance in poultry. Rev Mal Respir, 2004 Nov, 21(5 Pt 1), 993 - 6 {Pulmonary infection with Mycobacterium Malmoense, medico-surgical treatment.}; Job V et al.; CASE REPORT: We report the case of a patient with chronic obstructive pulmonary disease in whom pulmonary infection due to mycobacterium malmoense was discovered unexpectedly . A diagnostic and therapeutic surgical resection was performed . CONCLUSION: The non-tuberculous mycobacterium was identified by culture of the specimen . Surgery was followed by empirical antibiotic treatment with rifampicin and pyrazinamide for two and a half months . Isoniazid was withdrawn rapidly on account of hepatitis and the treatment was supplemented later with clarithromycin, leading to a total duration of treatment of seven and a half months . This case is unusual because of its medico-surgical management that led to assessment and appropriate treatment of this infection. HNO . 2004 Dec 22; {Epub ahead of print} {Naturopathic therapy for acute otitis media Eine Alternative zum primaren Antibiotikaeinsatz.}; Wustrow TP; BACKGROUND: First line antibiotic treatment of uncomplicated acute otitis media has been questioned.PATIENTS AND METHODS: In an prospective, open, controlled study, 390 children aged 1-10 years were treated either conventionally (free combinations of decongestant nose drops, mucolytics, analgesics and antibiotics) or alternatively with Otovowen, supplemented by conventional medications when considered necessary.RESULTS: Patients treated conventionally took more antibiotics (80.5% vs 14.4%) and analgesics (66.8% vs 53.2%) . The time to recovery (5.3 vs 5.1 days) and absence from school or pre-school nursery (both 1.7 days) were not significantly different between groups . Pain resolution was slightly better with conventional treatment (-5.8 vs -5.2 score points) . The alternative treatment was judged both by doctors, and parents, to be significantly better tolerated.CONCLUSION: In uncomplicated acute otitis media of childhood, an alternative treatment strategy with the natural medicine Otovowen may substantially reduce the use of antibiotics without disadvantage to the clinical outcome. J Vet Med A Physiol Pathol Clin Med, 2004 Dec, 51(9-10), 447 - 52 Efficacy of the non-antibiotic paste Protexin Hoof-Care for topical treatment of digital dermatitis in dairy cows; Kofler J et al.; In this study, the efficacy of the non-antibiotic paste Protexin Hoof-Care containing metallic salts and organic acids, was tested for local treatment of 26 acute digital dermatitis lesions . The control group (26 cases) was treated with local application of oxytetracycline spray . These 52 affected limbs with digital dermatitis were diagnosed in 47 dairy cows from eight different farms with slatted floors . The therapeutic effect was evaluated using a scoring system for weightbearing at stance, lameness at walk and pain of the digital dermatitis lesions . The pre-treatment and control examination scores were documented on days 0, 4, 10 and 28 . Both treatment regimens were effective, no statistical differences regarding the examined parameters was found between the group treated with the non-antibiotic Protexin Hoof-Care paste and the group treated with oxytetracycline spray . Twenty-seven digital dermatitis lesions required only one treatment with one of these products . A second topical treatment was carried out on day 4 in 13 lesions of the study group and in 12 lesions of the control group . The data of this pilot study indicate that the non-antibiotic paste Protexin Hoof-Care could be a valuable alternative to topical antibiotic treatment for digital dermatitis in dairy cattle. J Vet Med A Physiol Pathol Clin Med, 2004 Dec, 51(9-10), 439 - 46 Comparison of homeopathy, placebo and antibiotic treatment of clinical mastitis in dairy cows - methodological issues and results from a randomized-clinical trial; Hektoen L et al.; Based on the widespread use of homeopathy in treatment of animal disease and the poor documentation of its possible effects and consequences, a clinical trial was carried out in order to evaluate the efficacy of homeopathy in treatment of clinical mastitis in dairy cows and a design for clinical studies on homeopathic treatment, taking into account the guidelines for randomized-clinical trials (RCT) as well as the basic principles of homeopathy . A three-armed, stratified, semi-crossover design comparing homeopathy, placebo and a standardized antibiotic treatment was used . Fifty-seven dairy cows were included . Evaluation was made by two score scales, with score I measuring acute symptoms and score II measuring chronic symptoms, and by recording the frequencies of responders to treatment based on four different responder definitions . Significant reductions in mastitis signs were observed in all treatment groups . Homeopathic treatment was not statistically different from either placebo or antibiotic treatment at day 7 (P = 0.56, P = 0.09) or at day 28 (P = 0.07, P = 0.35) . The antibiotic treatment was significantly better than placebo measured by the reduction in score I (P < 0.01) . Two-thirds of the cases both in the homeopathy and placebo groups responded clinically within 7 days . The outcome measured by frequencies of responders at day 28 was poor in all treatment groups . Evidence of efficacy of homeopathic treatment beyond placebo was not found in this study, but the design can be useful in subsequent larger trials on individualized homeopathic treatment. HNO . 2004 Dec 18; {Epub ahead of print} {Antibiotic therapy in otorhinolaryngology.}; Federspil P et al.; First, the general principles for an antibiotic therapy are stated . The indications have to be well thought through . Frequent viral ENT infections, as well as numerous bacterial infections, should not be treated with antibiotics . Due to the current antibiotic sensitivity of the main ENT pathogens, the antibiotic choice for an empiric therapy is emphasized, and also the advantage of an optimized therapy based on the results of Gram stain (supercalculated empiric therapy) and an antibiogram (specific therapy) . Pus characteristics may be the first step in diagnosing the pathogens . The degree of severity of an infection determines the oral or parenteral route of administration . As a rule, antibiotic therapy has to be checked after 2-3 days . The grouping of the different ENT infections with a similar spectrum of pathogens gives a better view of the therapeutic principles and reduces repetitions . The current recommendations for antibiotic treatment of numerous ENT infections with different degrees of severity are indicated . After the presentation of the appropriate antibiotics with their current spectrum of efficacy, the initial therapy, treatment in case of penicillin allergy, and of severe cases and complications or therapeutic failure are mentioned. Magn Reson Imaging, 2004 Nov, 22(9), 1233 - 41 Bacterial pyomyositis: MRI and clinical correlation; Yu CW et al.; OBJECTIVE: To characterize the findings of magnetic resonance imaging (MRI) of bacterial pyomyositis (PM) and correlate these data with the clinical information . MATERIALS AND METHODS: Eighty-one patients were diagnosed with PM in our institute between 1997 and 2003 . Of these, 40 patients (21 male, 19 female; mean age, 53 years) also underwent MRI examination . The clinical manifestation underlying medical problems and the characteristics of MRI were analyzed . Thirty of the patients received surgical intervention or image-guided drainage/aspiration of the abscess along with administration of antibiotics, while the remaining 10 patients were promptly treated solely with antibiotics . RESULTS: Thirty-one of 40 patients had underlying medical problems . These involved diabetes mellitus (DM, n=16), malignancies including cervical cancer, prostate cancer, non-Hodgkin's lymphoma and acute lymphocytic leukemia (n=10, one case also had DM), autoimmune disease or asthma with long-term steroid usage (n=4, one case also had DM), liver cirrhosis (n=2) and chronic renal insufficiency (n=1) . Four patients had no abscess formation at presentation (invasive or early purulent stage), while the remaining 36 cases presented with at least one abscess (purulent stage) . Patients older than 40 years or DM patients tended to have larger abscess(s) (P<.05) . Gadolinium-enhanced images demonstrated either thick (n=12) or thin rim enhancement (n=24) of the abscess wall . For those 10 patients promptly treated solely with antibiotics, nine demonstrated thin rim enhancement of the abscess (P<.05) . CONCLUSION: Magnetic resonance imaging plays an important role in the early recognition of bacterial PM . By precisely demarcating the extent of the disease, MRI can allow planning prompt antibiotic treatment combined with or without interventional procedures. BMJ . 2005 Jan 15;330(7483):129 . Epub 2004 Dec 16. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital; Corwin P et al.; OBJECTIVES: To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital . DESIGN: Prospective randomised controlled trial . SETTING: Christchurch, New Zealand . PARTICIPANTS: 200 patients presenting or referred to the only emergency department in Christchurch who were thought to require intravenous antibiotic treatment for cellulitis and who did not have any contraindications to home care were randomly assigned to receive treatment either at home or in hospital . MAIN OUTCOME MEASURES: Days to no advancement of cellulitis was the primary outcome measure . Days on intravenous and oral antibiotics, days in hospital or in the home care programme, complications, degree of functioning and pain, and satisfaction with site of care were also recorded . RESULTS: The two treatment groups did not differ significantly for the primary outcome of days to no advancement of cellulitis, with a mean of 1.50 days (SD 0.11) for the group receiving treatment at home and 1.49 days (SD 0.10) for the group receiving treatment in hospital (mean difference 0.01 days, 95% confidence interval -0.3 to 0.28) . None of the other outcome measures differed significantly except for patients' satisfaction, which was greater in patients treated at home . CONCLUSIONS: Treatment of cellulitis requiring intravenous antibiotics can be safely delivered at home . Patients prefer home treatment, but in this study only about one third of patients presenting at hospital for intravenous treatment of cellulitis were considered suitable for home treatment. J Infect, 2005 Jan, 50(1), 68 - 71 Pulmonary melioidosis associated with bronchiolitis obliterans organizing pneumonia; Jansen A et al.; We report a case of pulmonary melioidosis associated bronchiolitis obliterans with organizing pneumonia (BOOP) . While antibiotic treatment alone did not show any major effect, addition of corticosteroids resulted in rapid clinical improvement . To our knowledge this is the first documented case of melioidosis associated with organising pneumonia . The possible therapeutic implications for the treatment of severe pulmonary melioidosis are discussed. J Pediatr Hematol Oncol, 2004 Dec, 26(12), 803 - 6 Pancytopenia, a rare hematologic manifestation of brucellosis in children; Karakukcu M et al.; The records of 54 children with brucellosis were evaluated retrospectively . Among them, eight patients (14.8%) with pancytopenia were identified in a 7-year period between 1996 and 2003 . Six of the eight patients with pancytopenia had Brucella melitensis isolated from blood cultures, and all eight patients had Brucella agglutination titers of at least 1:320 . Agglutination test titers did not correlate with the degree of pancytopenia . Fever was the most common manifestation, followed by malaise, anorexia, sweating, weight loss, and gastrointestinal symptoms . Most patients had hepatosplenomegaly, and bone marrow aspiration specimens showed hyper-cellularity or normocellularity . Hemophagocytosis (3 patients) and histiocytic hyperplasia (4 patients) were observed in bone marrow examinations of eight patients, but bone marrow aplasia and granulomas were not detected . All children recovered completely; the pancytopenia was transient and resolved after the antibiotic treatment of Brucella infection . Brucellosis should be considered as a possible diagnosis among patients with pancytopenia. Int J Clin Pract, 2004 Oct, 58(10), 937 - 44 Economic evaluation of the antibiotic treatment of exacerbations of chronic bronchitis and COPD in primary care; Llor C et al.; This was an observational and economic survey performed in primary care practices throughout Spain to assess the effectiveness and direct medical costs derived from antibiotic treatment of exacerbations of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) in primary care . A total of 252 physicians included 1456 valid patients, 80% were male and the mean age was 68.2 years (SD = 9.8) . The antibiotic treatment administered was moxifloxacin in 575 (39.5%), amoxicillin/clavulanate in 460 (31.6%) and clarithromycin in 421 (28.9%) . No significant differences were found in clinical and demographic characteristics between treatment arms . The 30-days follow-up visit was completed by 1097 (75%) patients, who were therefore valid for economic evaluation . During follow-up, 440 new medical visits were generated, 69 patients required attendance in emergency wards (6.3%) and 22 were hospitalised (2%) . The overall mean cost of exacerbation was Euro 118.58 {95% confidence interval (CI) = Euro 92.2-144.9} and Euro 52.44 (44.2%) were due to therapeutical failure . The mean cost of exacerbation was Euro 111.46 (95% CI = Euro 73.4-149.5) for patients treated with moxifloxacin, Euro 109.45 (95% CI = Euro 68.2-150.7) for those treated with amoxicillin/clavulanic acid and Euro 138.95 (95% CI = Euro 89.4-188.5) for patients receiving clarithromycin . In conclusion, a significant number of patients require new medical interventions after ambulatory treatment of exacerbations of CB or COPD . The mean cost of an exacerbation was Euro 118.58 and failure was responsible for 44.2% of the total cost of exacerbation. J Cancer Res Clin Oncol . 2004 Dec 3; {Epub ahead of print} Comparison of lenograstim and filgrastim: effects on blood cell recovery after high-dose chemotherapy and autologous peripheral blood stem cell transplantation; Huttmann A et al.; PURPOSE . The aim of the study was to evaluate whether glycosylated granulocyte colony-stimulating factor (G-CSF) (lenograstim) offers a benefit over non-glycosylated G-CSF (filgrastim) in clinically relevant end points after high-dose chemotherapy (HDC) and autologous peripheral blood stem cell transplantation (PBSCT) . METHODS . We retrospectively analyzed the outcome of 261 patients treated with either lenograstim ( n=68) or filgrastim ( n=193) . Time to blood cell recovery, toxicities, and infectious complications were analyzed in a total of 469 G-CSF treatment cycles . RESULTS . Mean time to leukocyte recovery was 10.7 days (SD+/-0.9) (lenograstim) and 10.8 days (SD+/-0.6) (filgrastim), respectively . Likewise, time to thrombocyte engraftment, febrile days, duration of therapeutic antibiotic treatment, severity of non-hematological toxicities, duration of in-hospital stay, and duration of G-CSF treatment were similar in both groups . Owing to the physicochemical and pharmacokinetic properties of lenograstim, the required dose until leukocyte recovery was significantly smaller as compared to filgrastim (38.5 vs 54.0 microg/kg of body weight) . CONCLUSIONS . Collectively, our data indicate that both G-CSF preparations are equally effective in hastening leukocyte recovery in the setting of high-dose chemotherapy followed by autologous PBSCT. Neuro Endocrinol Lett, 2004 Oct, 25(5), 373 - 80 The influence of antibiotic treatment on tocolysis in threatened advanced pregnancy; Bobrzynska M et al.; OBJECTIVE: The aim of this study was to determine: a) to what extent application of antibiotics enhances efficiency of tocolysis; b) whether the duration of antibiotic treatment influences its efficacy; c) what criterion is decisive for efficacy of tocolysis assisted by antibiotic therapy . MATERIALS AND METHODS: 223 successive women with unifetal pregnancies, aged 17 to 42 (average age 27.3), admitted to the Department of Gynecology and Obstetrics of the JU Medical College in the period from January 1, 1999 to September 9, 2001, were enrolled in the study . Using clinical methods such as: assessment of contractile activity of the uterus, of uterine cervix and membranes, presence of bleeding and other clinical symptoms, these women were diagnosed with imminent preterm labour . CONCLUSIONS: Antibiotic treatment enhances the efficacy of tocolysis, influencing the time of prolonging pregnancy in imminent preterm delivery . This synergistic effect is clinically crucial as in this way significantly larger number of children will be born at term and also a number of premature neonates who survive may be increased. Pediatrics, 2004 Dec, 114(6), e713 - 9 Indicators of acute bacterial meningitis in children at a rural Kenyan district hospital; Berkley JA et al.; OBJECTIVE: Acute bacterial meningitis remains an important cause of death and neurologic sequelae in African children . The clinical features of meningitis are often nonspecific and in this setting may overlap with those of malaria . Early diagnosis and appropriate antibiotic treatment are perhaps the most important steps in management, but published data suggest that fewer than half of the cases of childhood meningitis are identified at first assessment in hospitals in this region . The objective of this study was to identify clinical indicators of acute bacterial meningitis by examining components of the World Health Organization Integrated Management of Childhood Illness (IMCI) referral criteria for meningitis (lethargy, unconsciousness, inability to feed, stiff neck, or seizures) and other symptoms and signs . METHODS: Kilifi District Hospital, serving approximately 200,000 people in a rural, malaria-endemic area of the Kenyan coast, was studied . A Kenya Medical Research Institute research center is located at the hospital . All pediatric admissions aged > or =60 days between June 2001 and July 2002 were eligible . RESULTS: A total of 91 (2.0%) of 4582 admissions had meningitis, including 77 (4.0%) of 1929 of those who met the IMCI referral criteria for meningitis at admission (sensitivity: 85%; specificity: 59%) . Independent indicators of the presence of meningitis were a bulging fontanel, neck stiffness, cyanosis, impaired consciousness, partial seizures, and seizures outside the febrile convulsions age range . One or more of these indicators was present in 895 (19%) of admissions, 72 (8.0%) of whom had meningitis (sensitivity: 79%; specificity: 80%) . Independent indicators of the absence of meningitis were the absence of a history of fever, a history of diarrhea, and a positive malaria slide . The area under the receiver operating characteristic curve for a set of simple screening rules based on the positive indicators identified was 0.88 (95% confidence interval: 0.85-0.92) . CONCLUSIONS: The presence of > or =1 of a bulging fontanel, neck stiffness, cyanosis, impaired consciousness, partial seizures, and seizures outside the febrile convulsions age range is a clear indication for lumbar puncture and/or presumptive treatment . However, careful observation and reassessment may be the only practical way to identify one fifth of meningitis cases in this setting. Arch Bronconeumol, 2004 Dec, 40(12), 570 - 574 {Utility of bronchoalveolar lavage in immunocompromised children: diagnostic yield and complications}; Vega-Briceno LE et al.; OBJECTIVE: Immunocompromised children are at high risk for developing pneumonia due to opportunistic pathogens . The role of bronchoalveolar lavage (BAL) in the evaluation of such patients is still controversial . MATERIAL AND METHOD: We reviewed the hospital records of immunosuppressed patients with respiratory symptoms who had undergone BAL in the pediatric department of the Hospital Clinico de la Pontificia Universidad Catolica of Chile . RESULTS: Sixty-eight BAL were performed on 54 children (mean age: 7.5 years) receiving wide-spectrum antibiotic treatment . The most frequent respiratory signs and symptoms were fever (90%) and cough and respiratory distress (81%); 18% had neutropenia and 43% thrombocytopenia . A specific pathogen was identified in BAL samples for 25 patients (37%) . The pathogens isolated were bacteria in 21 cases, viruses in 6, Pneumocystis carinii in 5, fungi in 4, and Mycobacterium tuberculosis in one . Fourteen (19%) of the children who underwent BAL were on mechanical ventilation . Outcome was satisfactory in all cases . Twenty-one complications were recorded, 17 of which were minor (mild hypoxemia or fever) and 4 major, requiring tracheal intubation . No deaths were recorded . CONCLUSIONS: Evaluation by fiberoptic bronchoscopy together with BAL proved to be a safe procedure with an adequate diagnostic yield that made it possible to determine the etiology of the pulmonary infiltrates seen in chest x-rays . Both positive and negative results of BAL were useful for treating the patients. Obstet Gynecol Surv, 2004 Dec, 59(12), 816 - 8 Are complete blood cell counts useful in the evaluation of asymptomatic neonates exposed to suspected chorioamnionitis? Jackson GL, Engle WD, Sendelbach DM, Vedro DA, Josey S, Vinson J, Bryant C, Hahn G, Rosenfeld CR. Reportedly, chorioamnionitis complicates as many as 10% of pregnancies, and the condition poses a risk of neonatal infection . Affected women receive antibiotics, which may render neonatal blood cultures inconclusive . This prospective observational study was done to establish whether peripheral neutrophil counts might aid the diagnosis of neonatal infection and help decide the duration of antibiotic treatment . Participants were 856 near-term or term infants whose mothers were suspected of having chorioamnionitis . The infants received antibiotics for 48 hours unless clinical infection was present or a blood culture was positive . A blood culture was done and complete blood cell count (CBC) obtained within an hour of birth, and counts were repeated at approximately 12 and 24 hours . The results were analyzed using 2 reference systems, the ranges of Manroe et al . and the normal ranges of Schjelonka et al . Half the asymptomatic infants were followed up after discharge to identify recurrent infection.All but 4% of newborn infants were asymptomatic and had negative cultures . Antibiotics were discontinued at 48 hours in these cases . At least 1 abnormal neutrophil count was found in 99% of asymptomatic infants . Of infants having all 3 planned complete blood counts, 97% of those with symptoms had 1 or more abnormal neutrophil counts . Four infants (0.5%) had positive blood cultures, but 3 were asymptomatic . Eight of 404 asymptomatic infants who were followed up required rehospitalization within 3 weeks of discharge, 4 of them because of fever with a negative workup for sepsis and antibiotic treatment for less than 3 days . No infant had evidence of bacterial infection . The specificity and negative predictive values for abnormal neutrophil counts ranged from 0.12 to 0.95 and from 0.91 to 0.97, respectively . The range of sensitivity was 0.27 to 0.76 . Initial neutrophil counts differed depending on which reference values were used.Had neutrophil counts been used to determine the duration of antibiotic therapy in this population, local costs would have risen by $76,000 to $425,000 per year . Neither single nor serial neutrophil counts aid the diagnosis of early-onset infection, and they are not a helpful guide to the duration of antibiotic treatment in asymptomatic infants with negative cultures whose mothers are suspected of having chorioamnionitis. Indian J Pediatr, 2004 Nov, 71(11), 969 - 72 Comparison of two antibiotic regimens in the empirical treatment of severe childhood pneumonia; Cetinkaya F et al.; OBJECTIVE: The diagnosis and the treatment of community-acquired severe pneumonia is still a serious child health problem in developing countries . The aim of this study is to evaluate the effectiveness of two different antibiotic regimens in the empirical treatment of severe childhood pneumonia . METHODOLOGY: We enrolled 97 infants (aged 2-24 months) with severe community-acquired pneumonia in a randomized-controlled trial of 10 days of treatment with penicillin G+chloramphenicol (n:46) or ceftriaxone (n:51) . We evaluated the effectiveness of treatments with symptoms and some laboratory tests during and at the end of the study . RESULTS: The cure rates were similar in both groups and the antibiotic regimens in all patients were found effective (P< 0.001) . The number of nurse rounds was much more in penicillin plus chloramphenicol group than ceftriaxone group . CONCLUSION: Both penicillin G plus chloramphenicol and ceftriaxone are effective in the empirical treatment of severe community pneumonia of young children . In spite of more nurse visits for antibiotic treatment, penicillin G+ chloramphenicol combination may be a cheaper alternative to ceftriaxone in the treatment of childhood pneumonia. Acta Neurochir (Wien), 2005 Feb, 147(2), 159 - 66 Spinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies; Lohr M et al.; Background . Spinal epidural abscess (SEA) is a rare but potentially devastating disease requiring immediate surgical intervention and appropriate antibiotic treatment . The standard approach to decompress SEA is laminectomy . No report covers comprehensively the indications for the less invasive interlaminar approach, the usefulness of intra-operative ultrasonography and the suspected benefit of inserting a suction-irrigation drainage.Method . A retrospective evaluation of the medical and radiological data was undertaken in 27 consecutive patients with SEA operated on during a period of 10 years by a dorsal approach . Factors influencing outcome were evaluated with special regard to different surgical strategies concerning the invasiveness of the operative approach, the use of intra-operative ultrasound and the use of different drainage systems.Findings . Outcome was mainly determined by the pre-operative neurological condition and the localization of the abscess . Recurrence rate was dependent on the longitudinal extent of the mass and the intra-operative finding of granulation tissue, but not on the administration of a postoperative suction-irrigation drainage . An interlaminar approach was equally matched to a decompression by laminectomy in lumbar SEA concerning the incidence of residual/recurrent abscess formation . In concomitant spondylodiscitis, laminectomy bore the risk of the formation of a postoperative kyphotic deformity . The use of intra-operative ultrasound allowed the visualization of hidden inflammatory masses and, thus, reduced the rate of residual abscess formation.Conclusion . An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis . Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window . The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion. Ital Heart J, 2004 Sep, 5(9), 667 - 72 Effect of a short antibiotic treatment with roxithromycin on circulating adhesion molecules after coronary stenting: a single-center pilot trial; Vandoni P et al.; BACKGROUND: The aim of this study was to assess the effect of periprocedural antibiotic treatment with roxithromycin on circulating cell adhesion molecules and restenosis after coronary stent implantation . METHODS: Case-control study enrolling 25 consecutive patients submitted to coronary stenting for stable, single-vessel coronary artery disease, treated with 300 mg roxithromycin once daily for 5 days, starting 2 days before the procedure (group R) . Twenty-five patients, matched for lesion site, length and diameter, as control group (group C) . The serological status for Chlamydia pneumoniae (CP) infection (IgG, ELISA) was assessed in all patients . The plasma concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), E-selectin and C-reactive protein at 1 month after coronary stenting were compared with baseline values . Binary restenosis (> or = 50%) was also evaluated at 6 months . RESULTS: sICAM-1 significantly decreased at 1 month in group R vs group C (371 +/- 181 vs 573 +/- 273 ng/ml, p = 0.005) . This decrease was more evident in patients with a positive serology for CP (CP+) (group R 373 +/- 131 vs group C 597 +/- 255 ng/ml, p = 0.014) . Antibiotic treatment had no effects on circulating E-selectin levels at 1 month (56.7 +/- 97 vs 49.8 +/- 62 ng/ml, p = 0.54) . The restenosis rate (9/50, 18%) was similar in the two groups (group R 5/25 {20%}, group C 4/25 {16%}) . The restenosis rate was similar in the CP+ vs CP- group (6/35 {17%} vs 3/15 {20%}) . CONCLUSIONS: A short course of treatment with roxithromycin at the time of coronary stenting induces a significant reduction in the sICAM-1 levels at 1 month but apparently does not influence the restenosis rate. Crit Care, 2004 Dec, 8(6), R443 - 50 Epub 2004 Dec. G-CSF and IL-8 for early diagnosis of sepsis in neonates and critically ill children - safety and cost effectiveness of a new laboratory prediction model: study protocol of a randomized controlled trial {ISRCTN91123847}; Horisberger T et al.; INTRODUCTION: Bacterial infection represents a serious risk in neonates and critically ill paediatric patients . Current clinical practice is characterized by frequent antibiotic treatment despite low incidence of true infection . However, some patients escape early diagnosis and progress to septic shock . Many new markers, including cytokines, have been suggested to improve decision making, but the clinical efficacy of these techniques remains uncertain . Therefore, we will test the clinical efficacy of a previously validated diagnostic strategy to reduce antibiotic usage and nosocomial infection related morbidity . METHODS: All patients admitted to the multidisciplinary neonatal and paediatric intensive care unit of a university children's hospital will be included . Patients will be allocated either to routine sepsis work up or to the intervention strategy with additional cytokine measurements . Physicians will be requested to estimate the pre-test probability of sepsis and pneumonia at initial suspicion . In the treatment arm, physicians will receive raw cytokine results, the likelihood ratio and the updated post-test probability . A high post-test probability will suggest that immediate initiation of antibiotic treatment is appropriate, whereas a low post-test probability will be supportive of watchful waiting or discontinuing prophylactic empirical therapy . Physicians may overrule the suggestions resulting from the post-test probability . CONCLUSION: This trial will ascertain the clinical efficacy of introducing new diagnostic strategies consisting of pre-test probability estimate, novel laboratory markers, and computer-generated post-test probability in infectious disease work up in critically ill newborns and children. An Otorrinolaringol Ibero Am, 2004, 31(5), 441 - 6 {Chronic otitis media in adults complicated with meningitis . Report of two cases}; Pino Rivero V et al.; Although rare, meningitis secondary to chronic media otitis represent an intracranial complication of importance nowdays . We are reporting two clinical cases diagnosed by symptoms, CT and lumbar punction as meningeal syndrome with otogenic cause that required endovenous wide spectrum antibiotic treatment and surgery later . We consider essential an early diagnosis and close cooperation with other departments to try to decrease the associated mortality, greater than 30% in some series. Cesk Slov Oftalmol, 2004 Sep, 60(5), 342 - 7 {The therapy for acute acquired syphilitic uveitis}; Hlavackova K et al.; PURPOSE: In retrospective study (analysis) to report the effectiveness of therapy on anatomic and functional outcomes in patients with acute acquired syphilitic uveitis . DESIGN: Retrospective case-control study . PARTICIPANTS: 3 patients (4 eyes) with symptoms of ocular acute inflammation which occurred in latent stage of syphilis are included in our study . In all patients uveitis was the first clinical symptom of syphilis . METHODS: In all 3 patients the infection of acquired syphilis was diagnosed using specific and non-specific tests for treponemal antibody . In 2 eyes we performed diagnostic and therapeutic pars plana vitrectomy . The management of ocular syphilis in all patients consisted of mega units of aqueous penicillin intravenously or intramusculary, in 2 patients we used the combination with steroids . RESULTS: In 2 eyes with perioperatively obtained material of vitreous (during pars plana vitrectomy) specific treponemal antibody was detected using specific (TPHA) test . In the third patient infection was verified serologically . The final visual acuity of all 4 eyes is better than or equal to 6/12 . The visual acuity of one exe is 6/6 . CONCLUSION: Uveitis and neuroretinitis may be the first symptom of acquired syphilis in latent stage . Early antibiotic treatment significantly improves anatomical reparation of infection and visual outcomes. Braz J Infect Dis, 2004 Aug, 8(4), 272 - 80 Epub 2004 Aug. Audit of antibiotic use in a Brazilian University Hospital; Fonseca LG et al.; A cohort study was carried out at the Marilia Medical School Hospital . In the first phase the pattern of antibiotic use was evaluated . Antibiotics were prescribed for 55.4% of the patients; antibiotic combinations were used in 43% . Therapeutic use of antibiotics was considered inadequate in 27% . Respiratory and skin infections were the most frequently diagnosed . In up to 31% of the cases the treatment of respiratory infections was considered inadequate . The surgical use of antibiotic prophylaxis was evaluated in the second phase . Prophylaxis was indicated in 73.2% of the surgeries . The antibiotics most used for prophylaxis were first generation cephalosporins . In 78.9% of the surgeries, the antibiotic was correctly chosen . In 15.9% of the surgeries, the initial antibiotic administration was correctly timed . The use of antibiotics in the post-operative period was appropriate in 29.8% of the cases . The independent risk factors for surgical site infection (SSI), as determined by logistic regression analysis adjusted to class of wound risk, were the choice of antibiotic to be used prophylactically and the duration of antibiotic treatment in the post-operative period . Those who received appropriate prophylactic antibiotics had a lower rate of SSI than those who received innapropriated antibiotics {RR=0.49/95%; CI=0.25-0.90} . Patients who received prophylactic antibiotics correctly in the post-operative period had a lower risk of SSI than those who did not {RR=0.21/95%; CI=0.70-0.63} . The mean length of hospital stay was shorter among patients whose prophylactic treatment was correctly employed than among for which it was not {6.1 (+/-9.8) and 11.1 (+/-13.5) days, p=0.25}. Klin Monatsbl Augenheilkd, 2004 Nov, 221(11), 953 - 9 {Management of periorbital and orbital infections}; Knipping S et al.; BACKGROUND: Infections of the orbit and of the periorbital region are not uncommon . Even today they constitute a serious problem, in spite of modern antibiotic treatment, with a potential risk of lethal complications . Orbital infections are most prevalent in children and adolescents . The acute orbit has many causes, but the most frequent is an occurrence secondary to acute rhinosinusitis . PATIENTS AND METHODS: Based on clinical cases, different causes and the present state of diagnosis are presented . The discussion deals with therapeutic strategies depending on the stage according to the current classification of orbital inflammation . CONCLUSIONS: Orbital and periorbital inflammations represent a demanding challenge for interdisciplinary cooperation between ophthalmologists, ENT specialists and radiologists . In some cases maxillofacial surgeons and neurosurgeons have to be included as well . Accurate diagnosis and treatment may lead to the resolution of the infection and avoid ocular sequel or endocranial complications as well as a fatal outcome. Antimicrob Agents Chemother, 2004 Dec, 48(12), 4582 - 8 Effect of sucralfate on antibiotic therapy for Helicobacter pylori infection in mice; Watanabe K et al.; It has been documented that sucralfate, a basic aluminum salt, enhances the efficacies of antibiotics against Helicobacter pylori, resulting in eradication rates comparable to those associated with the use of proton pump inhibitors . However, its mechanism of action remains unclear . The aim of the present study was to investigate sucralfate's ability to complement antibiotic treatment of H . pylori infection in vivo . Four weeks following induced H . pylori infection, clarithromycin (CAM) and amoxicillin (AMPC) were administered orally to C57BL/6 mice for 5 days, both with and without sucralfate or lansoprazole . When sucralfate was concurrently given with CAM and AMPC at the maximum noninhibitory doses for the treatment of H . pylori infection, the bacterial clearance rates were comparable to those achieved by treatment with lansoprazole plus those antibiotics . The results of pharmacokinetic studies showed that lansoprazole delayed gastric clearance and accelerated the absorption of CAM, whereas sucralfate suppressed both gastric clearance and absorption . AMPC was undetectable in all samples . Scanning electron microscopy with a microscope to which a energy dispersive spectrometer was attached revealed that aluminum-containing aggregated substances coated the mucosa surrounding H . pylori in mice receiving sucralfate plus antibiotics, whereas the gastric surface and pits where H . pylori had attached were clearly visible in mice receiving lansoprazole plus antibiotics . The addition of sucralfate to the antibiotic suspension resulted in a more viscous mixture that bound to the H . pylori-infected mucosa and that inhibited the loss of CAM bioavailability in the acidic environment . Sucralfate delays gastric clearance of CAM and physically captures H . pylori through the creation of an adherent mucus, which leads to bacterial clearance. Dtsch Med Wochenschr, 2004 Nov 26, 129(48), 2609 - 13 {Sepsis management -- antibiotic therapy}; Welte T; Sepsis is one of the most frequent infectious problems at Intensive Care Units, and sepsis is associated with significant mortality . The latter could not be markedly reduced in the last years, despite a number of advances in the field of volume substitution, catecholamines, and endocrinologic therapy . The reason might be that important steps towards overcoming of sepsis are the surgical resection of infectious foci and an adequate antibiotic treatment . A critical role plays the growing resistance of pathogens against the common antibiotics . Since no major progress in the development of new antibiotics can be expected for the next years, sepsis treatment must be focused on prevention of infection, and on an optimised application of current antibiotic substances . The key factors are a broad and high dose initial treatment, a de-escalation strategy according to the clinical course, and -with exceptions- a limitation of treatment to 7 to 10 days . Rotation of antibiotics should be performed, if problems with resistances exist or no specialist for infectious diseases is available on the Intensive Care Unit. Am J Respir Crit Care Med . 2004 Nov 19; {Epub ahead of print} Hydrocortisone Infusion for Severe Community-Acquired Pneumonia: a Preliminary Randomized Study; Confalonieri M et al.; We hypothesize that hydrocortisone infusion in severe community-acquired pneumonia attenuates systemic inflammation and leads to earlier resolution of pneumonia and a reduction in sepsis-related complications . In a multicenter trial, patients admitted to the Intensive Care Unit (ICU) with severe community-acquired pneumonia received protocol-guided antibiotic treatment and were randomly assigned to hydrocortisone infusion or placebo . Hydrocortisone was given as an intravenous 200-mg bolus followed by infusion at a rate of 10 mg/h for 7 days . Primary end-points of the study were improvement in PaO2:FiO2 (PaO2:FiO2 >300 or >100 increase from study entry) and multiple organ dysfunction syndrome (MODS) score by study day 8 and reduction in delayed septic shock . Forty-six patients entered the study . At study entry, the hydrocortisone group had lower PaO2:FiO2, and higher chest radiograph score and C-reactive protein (CRP) level . By study day 8, treated patients had, in comparison to control, a significant improvement in PaO2:FiO2 (P = 0.002) and chest radiograph score (P < 0.0001) and a significant reduction in CRP levels (P = 0.01), MODS score (P = 0.003), and delayed septic shock (P = 0.001) . Hydrocortisone treatment was associated with a significant reduction in length of hospital stay (P = 0.03) and mortality (P = 0.009). Am Fam Physician, 2004 Nov 1, 70(9), 1685 - 92 Acute bacterial rhinosinusitis in adults: part I . Evaluation; Scheid DC et al.; Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory practice . Although often caused by viruses, it sometimes is caused by bacteria, a condition that is called acute bacterial rhinosinusitis . The signs and symptoms of acute bacterial rhinosinusitis and prolonged viral upper respiratory infection are similar, which makes accurate clinical diagnosis difficult . Because two thirds of patients with acute bacterial rhinosinusitis improve without antibiotic treatment and most patients with viral upper respiratory infection improve within seven d antibiotic therapy should be reserved for use in patients who have had symptoms for more than seven days and meet clinical criteria . Four signs and symptoms are the most helpful in predicting acute bacterial rhinosinusitis: purulent nasal discharge, maxillary tooth or facial pain (especially unilateral), unilateral maxillary sinus tenderness, and worsening symptoms after initial improvement . Sinus radiography and ultrasonography are not recommended in the diagnosis of uncomplicated acute bacterial rhinosinusitis, although computed tomography has a role in the care of patients with recurrent or chronic symptoms. HNO . 2004 Nov 11; {Epub ahead of print} {Diagnostic and therapeutic procedure for spontaneous emphysema of the neck and mediastinum.}; Koscielny S et al.; BACKGROUND . Emphysema without any etiological indices from the history represents a diagnostic and therapeutic challenge . PATIENT COLLECTIVE . Over the last 5 years, we treated four patients (three male, one female; aged 3-29 years) with cervical and/or mediastinal emphysema of unknown cause . RESULTS . Two young men with cervical emphysema were observed and received prophylactic antibiotic treatment . After involution of the emphysema, we performed an endoscopy which revealed no abnormalities . A female patient and a 3-year-old boy had a history of coughing and a query history of foreign body ingestion before the appearance of the emphysema . The immediate endoscopies were without pathologic findings . All patients recovered completely without any complications or recurrences . CONCLUSIONS . If there is no indication for a foreign body or a trauma in the history or in radiological imaging, endoscopy of the airways and the upper digestive tract should follow when the emphysema has subsided . The aim is to avoid any further spread of the emphysema and of pathogens . If there is a history of a foreign body or trauma, an immediate endoscopy is indicated. Mutagenesis, 2004 Nov, 19(6), 483 - 8 DNA damage studies in untreated and treated leprosy patients; Gandhi G et al.; The alkaline single cell gel electrophoresis assay was performed on peripheral blood lymphocytes of lepromatous and tubercloid leprosy patients (untreated and those undergoing treatment) in order to ascertain whether differential damage to DNA occurs . The study group included 28 male and 2 female patients and 15 healthy males who were matched for age and socio-economic status . The results revealed DNA damage in all patients, with a mean DNA migration length of 29.88 +/- 3.39 microm and 38% of their cells damaged when compared with the respective values obtained in healthy controls (1.28 +/- 0.40 microm, 5%) . Multiple regression analysis for effects of confounding factors revealed antibiotic treatment in patients and alcohol consumption in controls as the only variables influencing DNA damage . In lepromatous and tubercloid patients, both untreated and those undergoing treatment, DNA damage increased significantly from that observed in control individuals, with greater increased damage in lepromatous patients . An increase in treatment time increased DNA damage linearly . Furthermore, an arbitrary classification of damaged cells (categories I-IV) was made based on observed tail lengths in leprosy patients (5.00-225.00 microm) . The number of damaged cells in untreated patients was lower than in those undergoing treatment; the latter also had more cells with greater DNA migration lengths . There were no category III or IV cells in the control group . The results of the study therefore reveal that patients undergoing therapy had significantly greater DNA damage than untreated patients, indicating bacterial infection and drug therapy as the causal factors, since lepromatous-type disease is the more severe form with the patients having lower resistance to Mycobacterium leprae and requiring heavier and prolonged dosage of antibiotics . The study also corroborates that the assay offers an opportunity for correlating levels of therapy-induced DNA damage with administered dose and for modulating the dose-schedule so as to achieve lower levels of genotoxic damage. Acta Obstet Gynecol Scand, 2004 Dec, 83(12), 1202 - 7 Postoperative infections and antibiotic prophylaxis for hysterectomy in Sweden: a study by the Swedish National Register for Gynecologic Surgery; Lofgren M et al.; AIM: The purpose of the study was to evaluate the current use of antibiotic prophylaxis, the rate of postoperative infections, and risk factors for postoperative infections in patients undergoing elective hysterectomy for non-malignant pathology . METHODS: The study was performed during the time period July 2000 to 1 January 1 2003, using data from the Swedish National Register for Gynecologic Surgery, covering 26 of 49 clinics and approximately 50% of the Swedish population . During this time period, 3267 women undergoing elective hysterectomy for non-malignant pathology (mainly dysfunctional bleeding and fibromas) and with complete data on the use of antibiotic prophylaxis and postoperative follow up were included . A postoperative infection was considered to have developed if patients or the physician reported an infection related to the surgical site, together with reported use of antibiotic treatment . RESULTS: Among the 3267 patients, 341 (10.4%) were considered to have developed a postoperative infection . In cases where antibiotic prophylaxis had not been given, total abdominal hysterectomies and vaginal hysterectomies were associated with the highest frequency for postoperative infections P < 0.05 and P < 0.01, respectively . Notably, also women undergoing subtotal hysterectomy reported significantly lower rates of postoperative infections if prophylactic antibiotics had been given, P < 0.05 . Risk factors for postoperative infection were non-use of antibiotic prophylaxis, hospital, age less than 40 years, and BMI > 30 kg/m(2) . CONCLUSIONS: The study results have indicated the need of prospective clinical trials on antibiotic prophylaxis for patients undergoing supravaginal abdominal hysterectomy . Also, a need to further evaluate the current prophylactic antibiotic protocols used for obese patients and younger women undergoing any kind of hysterectomy is warranted. Mediators Inflamm, 2004 Aug, 13(4), 269 - 73 Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis; Taskin E et al.; AIMS: To determine the level of serum procalcitonin and cerebrospinal fluid cytokines in children with bacterial or viral meningitis and to document the use of these parameters in differential diagnosis . RESULTS: Before the start of antibiotic treatment, serum procalcitonin and tumor necrosis factor alpha levels were found to be higher in acute bacterial meningitis compared with viral meningitis and with the control group . Similarly, cerebrospinal fluid interleukin-6 levels were found to be significantly higher in children with acute bacterial meningitis compared with viral meningitis . However, no significant difference was determined between groups in respect to the cerebrospinal fluid interleukin-8 level . CONCLUSION: Serum procalcitonin and cerebrospinal fluid tumor necrosis factor alpha levels can be used in the early diagnosis of bacterial meningitis . Similarly, they may be useful adjuncts in differential diagnosis of bacterial and viral meningitis. J Med Entomol, 2004 Sep, 41(5), 894 - 900 Characterization of Wolbachia infections and interspecific crosses of Aedes (Stegomyia) polynesiensis and Ae . (Stegomyia) riversi (Diptera: Culicidae); Dean JL et al.; Prior studies have identified a complicated pattern of interspecific hybridization between members of the Aedes (Stegomyia) scutellaris (Walker) mosquito group, which includes medically important vectors of bancroftian filariasis and dengue . Here, we report that two members of the group, Aedes polynesiensis Marks and Aedes riversi Bohart & Ingram, are both infected with intracellular Wolbachia bacteria . Sequencing of the Wolbachia wsp gene demonstrates that the infections differ from each other and from Wolbachia infections previously reported in mosquitoes . Aedes polynesiensis is the first mosquito identified with a wMel Wolbachia type . Intraspecific crosses of infected and aposymbiotic lines generated via antibiotic treatment show that the Wolbachia infections in both species cause high levels of cytoplasmic incompatibility . Interspecific crosses show that the two species are reproductively isolated . However, repeating the interspecific crosses with aposymbiotic mosquito strains demonstrates that the Wolbachia infections play a role in preventing hybrid offspring . We discuss Wolbachia infections in relation to better defining the evolutionary relationships and causes of speciation within the group, understanding the basis for the observed east-to-west gradient in filarial refractoriness, and developing novel genetic control measures. Eur J Obstet Gynecol Reprod Biol, 2004 Nov 15, 117 Suppl 1, S2 - 5 Perspectives in the prevention of premature birth; Ancel PY; Obstetric and neonatal interventions have improved the survival of preterm infants, but there has not been an equivalent reduction in long-term neurological disability . Thus, some effort must be invested in finding ways of preventing preterm birth . Numerous programmes have been promoted to address the matter of how the frequency of preterm birth could be prevented . Most interventions intended to prevent preterm labour do not have the desired effect, except for antibiotic treatment in cases of asymptomatic bacteriuria or bacterial vaginosis and progesterone administered prophylactically in high-risk women . Tocolytic drugs appear to delay delivery long enough for successful administration of corticosteroids in women in preterm labour, but without decreasing the risk of preterm birth . Some authors promote public health approaches that address all risk factors and affect the entire population of pregnant women, given that prevention programmes directed only at high-risk women have had little effect in preventing preterm births . However, the lack of progress in reducing the frequency of preterm births is also due to our limited understanding of the aetiology of preterm delivery . Although there is growing evidence that infection and neuroendocrine processes are involved, progress has remained slow . Recently, the hypothesis of a genetic predisposition to preterm delivery has been set up . Additional research exploring the pathophysiology of preterm labour is obviously needed, which will hopefully lead to the development of new therapeutic approaches. J Clin Epidemiol, 2004 Oct, 57(10), 1063 - 70 Mass mailing and telephone contact were effective in recruiting veterans into an antibiotic treatment randomized clinical trial; Resio MA et al.; OBJECTIVE: Achieving enrollment goals of randomized clinical trials (RCT) within budgets depends on the timely recruitment of sufficient numbers of participants . We report a comparison of recruitment methods and yields of previously deployed veterans into a large RCT . STUDY DESIGN AND SETTING: A retrospective survey concerning recruitment was administered to staff at 28 sites participating in the VA Cooperative Study #475, "Antibiotic Treatment of Gulf War Veterans' Illnesses" (GWVI) . RESULTS: Twenty-one sites reported identifying 31,407 Gulf War Veterans (GWV) . Of these, 13.7% were successfully contacted, 3.5% were enrolled, and 1.2% were randomized . Mass mailings and direct telephone calls to GWV identified from a GWV database accounted for 78% of the GWV contacted . The other 22% were contacted by using referrals from medical staff, veterans' groups, media advertisements, and other methods . Data collected prospectively at the Albany Stratton VAMC were similar to data collected retrospectively from other sites . CONCLUSION: These findings demonstrate that in previously deployed GWV with GWVI, 1.2% could be randomized . Although the use of all recruitment methods combined achieved the study recruitment goal, these data demonstrate that mass mailing and direct telephone contacts were effective recruitment methods. Rom J Intern Med, 2003, 41(3), 237 - 46 Rovamycine as add-on treatment in unstable angina and 4 year evolution with major cardiovascular events; Radoi M et al.; BACKGROUND: Major antibiotic trials targeting Chlamydia Pneumoniae or the pathogen burden in acute coronary syndromes reported conflicting data . Only a minor impact of antibiotic treatment on major cardiovascular events (MACE) incidence was demonstrated in some studies . METHODS AND RESULTS: 109 unstable angina patients were randomised in: group C receiving conventional treatment, group R treated with Rovamycine 12 days 4.5 MUI iv /day as add-on therapy, group R1 treated with Rovamycine 12 days 4.5 MUI iv/day followed by 6 MUI/day per os for another 12 days add on treatment . Randomisation into the therapeutical groups was independent of the serological status for Chlamydia pneumoniae . The primary adverse end-points of the study were the incidence of major cardiovascular events at 3 months, 6 months and at 4 years and the 4 years cumulated end-point rate . Secondary adverse end-points were the incidence of recurrent stable angina at 3 and 6 months and the incidence of increased serum levels of C reactive protein and fibrinogen at 3 and 6 months . Statistics used multiple regression analysis and Chi square test . At 6 months the incidence of unstable angina with readmission was significantly lower in groups R and R1 compared to group C (p < 0.001, respective p < 0.0001) and significantly lower in group R1 compared to group R (p < 0.0001) . The incidence of nonfatal myocardial infarction at 6 months was significantly lower in groups R and R1 compared to group C (p < 0.0001) . The incidence of cardiovascular death was significantly lower in group R1 compared to group C and R (p < 0.001) . At 4 years the incidence of unstable angina with readmission and the cumulated end point rate were significantly reduced in groups R and R1 compared to group C . The 3 months incidence of increased serum levels of C reactive protein was significantly decreased in group R1 compared to groups C and R (p<0.001) . The 3 months incidence of increased serum levels of fibrinogen was significantly lower in groups R and R1 compared to group C (p<0.002, respectively p<0.001) . CONCLUSIONS: In patients with unstable angina Rovamycine as add-on treatment to the conventional treatment lead to a significant decrease of MACE incidence at 6 months and to a significant decrease in the 4 years incidence of unstable angina with readmission . The beneficial effect of Rovamycine was parallel to the decrease in serum inflammations markers concentration. Przegl Lek, 2004, 61(5), 463 - 6 {Treatment of croup syndrome in children in Poland: results of the prospective multi-center observation}; Pejcz J et al.; The aim of the study was to estimate treatment practice in hospital management of croup syndrome (laryngitis subglottica) in children in Poland . MATERIAL AND METHODS: During the period of 12 months, we have prospectively observed 482 children with croup syndrome admitted to 15 pediatric departments in Lower Silesia (south-west region of Poland) . Data concerning epidemiology, clinical course and treatment were collected from uniform observation cards . There were 326 boys and 156 girls aged between 2 and 174 months in our study . RESULTS: Among 482 observed children, received glucocorticoids 424 (88%) mainly parenteraly, L-epinephrine--211 (43.8%), mist therapy--241 (50%), antihistamines--308 (63.9%), antibiotics--280 (58.1%) . Children treated with antibiotics were younger (p=0.0316), their temperature, amount of leukocytes and value of C-reactive protein was higher when compared with those not treated (p=0.0002; p=0.0081, p=0.0172 respectively) . CONCLUSIONS: Children in Lower Silesia with croup syndrome were treated in agreement with recent standards with glucocorticoids and/or epinephrine . There was an excessive usage of antihistamines which have no established treatment role . It seems that in many cases antibiotic treatment could have been avoided. Acta Otolaryngol, 2004 Aug, 124(6), 655 - 63 Sinusitis of odontogenic origin: pathophysiological implications of early treatment; Legert KG et al.; Although sinusitis is a common condition its pathogenesis is not clearly understood and there is lack of consensus concerning its treatment and prevention . Sinusitis is regarded as being primarily rhinogenous in origin, and oral/dental infections are considered to be predisposing factors . A review of the literature suggests that many cases of recurrent acute sinusitis are due to secondary rhinogenous bacterial colonization of antral mucosa that have been weakened and degenerated by chronic dental infection/inflammation . Unless the underlying dental condition, which may be asymptomatic or mildly symptomatic, is diagnosed and treated, the value of antibiotic treatment in such cases is questionable . In order to halt disease progression and avoid excessive antibiotic treatment, early intervention (both preventive and therapeutic) is necessary . Further research is required to establish the sequence of events by which infection of odontogenic origin initiates degenerative changes in the antral mucosa, culminating eventually in sinusitis. Z Geburtshilfe Neonatol, 2004 Oct, 208(5), 170 - 3 {Conservative treatment of breast abscesses in lactating women with sonographically guided aspiration and oral antibiotics}; Rageth CJ et al.; BACKGROUND: Breast abscesses have usually been treated by incision and drainage . During the past 10 years conservative treatment with repeated ultrasound-guided drainage to evacuate the abscess combined with antibiotic treatment has become a valuable alternative . PATIENTS AND METHODS: From 1991 to 2003 the authors treated 17 patients with puerperal abscess with this method . Under local anesthesia with ultrasound guidance a thick needle (preferably a Venflon) is introduced into the cavity . The procedure is repeated every two or three days until the ultrasound image demonstrates a diameter of the cavity of 1.5 cm or less . The oral antibiotic treatment lasts for 6 to 10 days . RESULTS: In 7 cases only one puncture was needed, 5 cases needed 2 punctures while 4 women needed 3 or more punctures (up to 5) . In 16 cases an open drainage could be avoided . One patient wanted to discontinue the conservative treatment after the first puncture and requested the surgical drainage . CONCLUSIONS: Conservative therapy with ultrasound-guided drainage of puerperal breast abscesses can therefore be recommended as a standard treatment. Contraception, 2004 Nov, 70(5), 393 - 9 Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study; Rorbye C et al.; To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted . We compared the outcome of 1135 consecutive women with gestational age (GA) < or = 63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia) . One hundred eleven of these women were randomized for abortion method . Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system . Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires . The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate {97.7% (708/725) vs . 94.1% (386/410), p < .01} and also with a higher risk of antibiotic treatment than medical abortion {7.8% (37/467) vs . 3.7% (13/356), p < .05} . The median leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p < .05 . On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit . We conclude that the chance of a primary successful termination at GA < or = 63 days is higher after a surgical abortion in general anesthesia compared to a medical abortion induced with 600 mg mifepristone and 1 mg gemeprost . A surgical abortion is associated with an increased risk of antibiotic treatment compared to medical abortion . The women's need for follow-up might be higher than we expect. Eur J Pediatr, 2004 Nov, 163(11), 646 - 50 Epub 2004 Jul 28. Persistent synovitis in children with Lyme arthritis: two unusual cases . An immunogenetic approach; Hendrickx G et al.; We report on two patients with a persistent Lyme arthritis . In addition both had a peculiar disease history . The first patient had oligoarticular juvenile idiopathic arthritis in remission . Five months after an infected tick bite, she developed a relapse of arthritis in the same knee . We considered Lyme borreliosis as the possible trigger for this reactivation . The disease history of the second patient was that of a classical non-responder . After extensive antibiotic treatment osteolytic lesions became visible . MRI images suggested an erosive arthropathy and arthroscopy was used to investigate possible erosive arthritis . Studies on collected material made us consider the following hypothesis . Despite demonstration of a spirochete fragment in a synovial biopsy, the patient recovered without additional antibiotic treatment . CONCLUSION: delay of antibiotic treatment after appearance of erythema migrans may cause systemic spread of the antigen and predispose to Lyme arthritis . If intra-articular steroids are considered when spontaneous resolution of Lyme arthritis does not occur, magnetic resonance imaging of the affected joint, prior to administration, may provide additional information . The success of synovectomy may be related to removal of undegraded antigenic material which may prolong the inflammation. Cochrane Database Syst Rev . 2004 Oct 18;(4):CD000245. Antibiotics for acute bronchitis; Smucny J et al.; BACKGROUND: Antibiotic treatment of acute bronchitis, which is one of the most common illnesses seen in primary care, is controversial . Most clinicians prescribe antibiotics in spite of expert recommendations against this practice . OBJECTIVES: The objective of this review was to assess the effects of antibiotic treatment for patients with a clinical diagnosis of acute bronchitis . SEARCH STRATEGY: In this updated review, we searched the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to March 2004); EMBASE (January 2000 to December 2003); SciSearch from 1989 to 2004; reference lists of articles and the authors' personal collections up to 1996, and also wrote to study authors and drug manufacturers . EMBASE has previously been searched from 1974 to 2000) . SELECTION CRITERIA: Randomised controlled trials comparing any antibiotic therapy with placebo in acute bronchitis or acute productive cough without other obvious cause in patients without underlying pulmonary disease . DATA COLLECTION AND ANALYSIS: At least two reviewers extracted data and assessed trial quality . Authors were contacted for missing data . MAIN RESULTS: Nine trials involving over 750 patients aged eight to over 65 and including smokers and non-smokers were included in the primary analysis . The quality of the trials was variable . A variety of outcome measures were assessed . Overall, patients receiving antibiotics had better outcomes than did those receiving placebo . At a follow-up visit, they were less likely to have a cough (relative risk (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.85; number-needed-to-treat (NNT) 5; 95% CI 3 to 14), show no improvement on physician assessment (RR 0.52; 95% CI 0.31 to 0.87; NNT 14; 95% CI 8 to 50), or have abnormal lung findings (RR 0.48; 95% CI 0.26 to 0.89; NNT 11; 95% CI 6 to 50); and had shorter durations of cough (weighted mean difference 0.58 days; 95% CI 0.01 to 1.16 days), productive cough (weighted mean difference (WMD) 0.52 days; 95% CI 0.01 to 1.03 days), and feeling ill (WMD 0.58 days; 95% CI 0.00 to 1.16 days) . There were no significant differences regarding the presence of night cough, productive cough, or activity limitations at follow up, or in the mean duration of activity limitations . The benefits of antibiotics were less apparent in a sensitivity analysis that included data from two other studies of patients with upper respiratory tract infections with productive cough . There was a non significant trend towards an increase in adverse effects in the antibiotic group, relative risk (RR) 1.22 (95% CI 0.94 to 1.58) . REVIEWERS' CONCLUSIONS: Overall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis . The magnitude of this benefit, however, is similar to that of the detriment from potential adverse effects. Clin Infect Dis, 2004 Nov 1, 39(9), e95 - 7 Epub 2004 Oct 06. Mass antibiotic treatment and community protection in trachoma control programs; Chidambaram JD et al.; Azithromycin is highly effective against trachoma, but the practical difficulties of community-wide distribution often leave many individuals untreated . We demonstrate, after mass azithromycin treatment of a population in Ethiopia, an indirect protective effect that occurred among untreated children who resided in villages in which most individuals had been treated . Similarities with the indirect protection within a treated community (i.e., "herd protection") that has been observed in vaccination programs are discussed. Parasite Immunol, 2004 May, 26(5), 207 - 11 Serum levels of soluble urokinase plasminogen activator receptor is associated with parasitemia in children with acute Plasmodium falciparum malaria infection; Perch M et al.; Serum levels of soluble urokinase plasminogen activator receptor (suPAR) are significantly elevated and of prognostic value in patients suffering from serious infectious diseases such as HIV and tuberculosis . Our objective was to investigate suPAR levels during symptomatic malaria infection and 7 days after treatment . Children younger than 6 years who presented with fever or other symptoms compatible with malaria were enrolled . Blood films and samples were collected on day 0 and day 7 . Twenty-five children were allocated to each of three groups according to the amount of Plasmodium falciparum detected in their initial blood film . Children in group 1 had parasite densities in excess of 20 parasites per 200 leucocytes . The median plasma suPAR level was 6.49 ng/mL (interquartile range {IQR}: 4.90-7.61) and correlated to parasitemia (Spearman 0.43, P < 0.0001) . Blood was obtained from 20 children in group 1 after 7 days of treatment . All became malaria negative in their blood slides and all decreased in suPAR level to median 3.48 ng/mL (IQR: 3.08-3.91) (P < 0.0001) . Group 2 consisted of 25 children with 1-20 parasites in their blood slide . The suPAR level was median 2.91 ng/mL (IQR: 2.27-4.40) and decreased with median 0.5 ng/mL following treatment (P = 0.0002) . Group 3 showed to be negative in their blood slides and most received antibiotic treatment . suPAR decreased from median 3.26 ng/mL (IQR: 2.77-4.46) to median 2.47 ng/mL (IQR: 2.01-3.75), on day 7 (P = 0.006) . This study demonstrates an important association between suPAR and acute malaria infection in humans. Br J Dermatol, 2004 Oct, 151(4), 809 - 16 Combined in vivo and in vitro approach for the characterization of penicillin-specific polyclonal lymphocyte reactivity: tolerance tests with safe penicillins instead of challenge with culprit drugs; Sachs B et al.; BACKGROUND: Amino-penicillins are a major cause of delayed-type reactions to penicillins . OBJECTIVES: The aim of this study was to establish a diagnostic approach for the characterization of the individual penicillin-specific polyclonal lymphocyte reactivity in order to detect side chain-specific sensitization to amino-penicillins . Patients can then be advised to undergo a tolerance test with safe penicillins instead of provocation with culprit penicillins for confirmation of penicillin allergy . METHODS: We investigated penicillin-specific polyclonal lymphocyte reactivity in nine patients with delayed-type reactions to amino-penicillins by a combined in vivo (patch, prick and intracutaneous tests with delayed readings) and in vitro (lymphocyte transformation test, LTT) approach . RESULTS: A combination of LTT and skin tests improved the sensitivity for the characterization of penicillin-specific polyclonal lymphocyte reactivity and allowed the detection of three different patterns of lymphocyte reactivity . Four patients showed a side chain-specific sensitization to amino-penicillins in vivo and in vitro and were advised to undergo tolerance tests with safe penicillins . Two patients agreed and were exposed to parenteral benzyl-penicillin and oral phenoxymethyl-penicillin which they tolerated without complications . CONCLUSIONS: These data suggest that a combined in vivo and in vitro approach is helpful for the detection of side chain-specific sensitization to amino-penicillins . Patients with such sensitization are very likely to tolerate safe penicillins, thereby expanding their therapeutic options when antibiotic treatment is required. Enferm Infecc Microbiol Clin, 2004 Oct, 22(8), 455 - 61 {Clinical study and analysis of risk factors for mortality in 86 cases of infectious endocarditis in children and adolescents in Argentina: 1988-2000}; Paganini H et al.; INTRODUCTION: IE is a rare infection in children . Scarce reports with large number of patients are published . METHODS: Between January 1988 to December 2000 we analyzed all cases of IE cases admitted to our hospital . RESULTS: 86 cases of IE (4.9/10,000 admissions) in 86 children were diagnosed . The median age was 7.6 years . In 77% of patient previous cardiac disease was detected, interventricular defects and Tetralogy of Fallot were the more frequent . Three percent of children had rheumatic heart disease . Thirty-six percent of children had previous heart surgery . Fifty-seven percent have been received previous antibiotics . Eighty-seven percent had positive blood cultures, being the S . aureus and S . viridans the predominantly . Forty-eight percent of children had complications . The metabolic disorders and the nosocomial infections were the most frequent . Twenty-four percent required surgery, 24% of them in the first week of the diagnosis . The mortality in operated children was 19% . In the multivariate analysis we could observe that children with more than 7 years and S . aureus isolation in blood cultures had more incidence of complications and posterior surgery (p < 0.05) . Children with S . aureus IE had longer duration of fever, more incidence of complications than patients with S . viridans IE (p < 0.05) . Ten percent of children were treated as outpatients . The global mortality was 12,8% . Previous surgery (OR = 6.89; IC 95% 1.54-30.7) and previous antibiotic treatment (OR = 9.98; IC 95% 1.12-88.8) were the factors related with higher mortality in the multivariate analysis . S . aureus was the predominat pathogen and caused more morbidity and mortality than S . viridans IE . CONCLUSION: Children with IE with previous surgery and previous antibiotic treatment died with more frequency. Expert Rev Anti Infect Ther, 2003 Aug, 1(2), 209 - 16 The effect of antibiotic treatment on active trachoma and ocular Chlamydia trachomatis infection; Mabey D et al.; Antibiotics are one of four arms of the SAFE strategy for the control of trachoma, an eye infection that is responsible for more cases of blindness than any condition other than cataract . The evidence for the use of topical tetracycline and oral tetracycline, doxycycline, erythromycin, cotrimoxazole and azithromycin in trachoma are reviewed here and a number of issues are nominated as research and policy priorities. Virchows Arch . 2004 Oct 5; {Epub ahead of print} Combined mucormycosis and aspergillosis of the oro-sinonasal region in a patient affected by Castleman disease; Maiorano E et al.; One case of aspergillosis and mucormycosis occurring in a patient with stage-IV Castleman disease was investigated . The patient, who had undergone polychemotherapy and was in otherwise good general condition, without lymphadenopathies or imbalance of the immune system, presented with a palatal ulceration that progressively involved the palatal mucosa and bone, the paranasal sinuses and the orbit . Repeated cultural examinations were always negative . He had undergone multiple cytological smears of the inflammatory infiltration and biopsies of both the oral and nasal mucosa, which resulted in extensive necrotic debris and suppurative inflammation, and, on the very last biopsy, fungal hyphae, spores and conidia were also detected . These were large, branching, mostly non-septate hyphae, associated with conidiophores and conidia, the latter appearing dark brown to black in the histological preparations . Following the diagnosis of combined mucormycosis and aspergillosis, the patient underwent prolonged topic and systemic antibiotic treatment that resulted curative . Mucormycosis usually is a fatal complication of head and neck or systemic disorders, leading to severe immune suppression . Nevertheless, early diagnosis may be achieved using a combination of special stains and may lead to effective antibiotic treatment and cure of the patient, even if associated with other opportunistic infections, such as aspergillosis. Orthopade, 2004 Nov, 33(11), 1309 - 18; quiz 1319-20 {Acute joint infection--diagnostic and treatment}; Jerosch J; The acute joint infection is a rare condition; the delayed diagnosis may lead to significant joint destruction . Diagnostic tools are the c-reactive protein and joint aspiration . Today arthroscopic treatment options are suitable tools for the treatment of such conditions . Arthroscopic lavage and debridement with additional systemic antibiotic treatment proofed to be very effective in an infected joint . If there are continuous signs of infection even with antibiotic treatment, rearthroscopy within few days is indicated . The number of rearthroscopies is related to the initial stage of the infection . With a shaver thorough debridement of all necrotic tissue as well as resection of adhesions is performed without complete resection of the intact and noninfected synovial membrane . The use of intraarticular resorbable antibiotic fleece is possible, but not generally recommended . Suction irrigation systems are only rarely indicated . If there is bony involvement, open arthrotomy still is the golden standard. J Hosp Infect, 2004 Oct, 58(2), 128 - 36 Strategies for the diagnosis and treatment of bacteraemia in children with central venous catheters: an analysis; Ferroni A et al.; The aim of this study was to analyse the diagnostic, empirical and therapeutic strategies adopted when a blood culture from a hospitalized child with a central venous catheter is 'positive', and to assess whether practices complied with the consensus adopted in our hospital, inspired by published recommendations . One hundred and ten cases of bacteraemia were studied prospectively . Investigations to determine whether the catheter was the cause of infection were carried out in 45% of cases, and the catheter was removed as recommended in 39% of cases . Of the patients that received empirical treatment, 56% received broad-spectrum antibiotics with no apparent clinical justification . Following susceptibility testing on the isolated strain, the antibiotic treatment was considered to be appropriate in 58% of cases . Overall, compliance with the consensus recommendations was poor . This was partly due to the high turnover rate of antibiotic prescribers. Clin Infect Dis, 2004 Oct 1, 39(7), 955 - 63 Epub 2004 Sep 08. Improvement of process-of-care and outcomes after implementing a guideline for the management of community-acquired pneumonia: a controlled before-and-after design study; Capelastegui A et al.; BACKGROUND: Studies investigating the impact of guideline implementation for inpatient management of community-acquired pneumonia (CAP) usually have methodological limitations . We present a controlled study that compared interventions before and after the implementation of a practice guideline . METHODS: Clinical and demographic characteristics, as well as process-of-care and outcome indicators, were recorded for all patients with CAP who were admitted to Galdakao Hospital (Galdakao, Spain) in the 19-month period after the implementation, on 1 March 2000, of a guideline for the treatment of CAP . These data were also recorded for all patients with CAP who were admitted to this hospital during the year before the guideline was implemented, as well as for randomly selected inpatients with CAP at 4 other hospitals during both periods (i.e., before and after guideline implementation) who were chosen as an external comparison group . Multivariate linear and logistic regression models were employed for adjustment . RESULTS: Guideline implementation resulted in shorter durations of antibiotic treatment (P<.001) and intravenous treatment (P<.001), better coverage of atypical pathogens (P<.001), and improved appropriateness of antibiotic treatment (P<.001), compared with the period before the guideline was implemented . The adjusted analyses revealed decreases in 30-day mortality (odds ratio {OR}, 2.14; 95% confidence interval {CI}, 1.23-3.72) and in-hospital mortality (OR, 2.46; 95% CI, 1.37-4.41) and a 1.8-day reduction in the duration of hospital stay . In the control hospitals, there were small but statistically insignificant changes in these indicators for admitted patients . CONCLUSIONS: This study, which was performed with an adequate, controlled before-and-after intervention design, demonstrated significant improvements in both process-of-care and outcome indicators after implementation of a guideline for treating CAP. Acta Otorhinolaryngol Ital, 2004 Apr, 24(2), 83 - 6 Cranio-cervical necrotizing fascitiis: case report and review of the literature; Dallan I et al.; Necrotising fascitiis is a rapidly progressive bacterial infection of the soft tissues and generally attacks the walls of the abdomen, the perineum, the limbs or, to a lesser degree, the cranio-cervical area . In the latter region, the infection involves the soft tissues of the neck, in a more or less extensive manner, and causes diffuse necrosis . Crepitation, areas with linear infiltration and others with fluctuation are detected on manual examination . Systemic symptoms such as fever, tachycardia, tachypnoea and signs of septic shock are always present, at least during the more advanced stages of the disease . Computed tomography may prove fundamental since it reveals an increase in the thickness and degree of impregnation of the cervical soft tissues, as well as the presence of liquid or gaseous infiltration in the thoracic areas, especially in cases of mediastinitis . Personal experience in a case is described which led to a review of the literature . The best approach in the management of this devastating condition is early diagnosis, adequate antibiotic treatment and radical surgical procedures, which may often need to be repeated several times. Biol Neonate, 2005, 87(1), 51 - 5 Epub 2004 Sep 30. Role of antibiotics in management of non-ventilated cases of meconium aspiration syndrome without risk factors for infection; Lin HC et al.; There are limited data on the efficacy of antibiotics in the management for meconium aspiration syndrome (MAS) . This purpose of the prospective randomized controlled clinical trial compared the infection-related outcome of non-ventilated cases of MAS without perinatal risk factors for infection, treated with or without antibiotics therapy, as measured by the incidence of pneumonia and sepsis up to the age of 2 months . From January 1997 to July 2003, this study was carried out in our nursery . Infants with MAS without perinatal risk factors for infection and without ventilator use were randomly allocated to study and antibiotics groups after informed parental consent was obtained . The study group did not receive antibiotics, while the antibiotics group received antibiotics including ampicillin and gentamicin for 3 days until the blood cultures were negative, as was standard practice in the nursery . Other management and monitoring of MAS were the same in both groups . Of a total of 425 cases of MAS, 119 cases were excluded because there were at risk for infection or respiratory failure needing ventilator support . The study group comprised 148 cases and the antibiotics group 158 cases . Among these patients, 127 from the study group and 132 from the antibiotics group were followed up until 2 months of age . The profile of patients with respect to the method of delivery, the characteristics of meconium, Apgar score, sex, gestational age and birth body weight was similar in both groups . There were no significant differences in the duration of tachypnea, O2 supplementation and nasal continuous positive airway pressure (CPAP) between the two groups . Pneumothorax occurred in 4 cases in the study and 7 cases in the control group . There was no mortality in either group . Blood cultures at 6 and 72 h of age were all negative in both the study and the antibiotics groups . No infant developed bacterial pneumonia, sepsis or meningitis in the follow-up program at 2 months of age . We conclude that antibiotic treatment did not affect the clinical course and outcome related to infection in MAS without perinatal risk factors for infection and without ventilator use . The role of antibiotics in the management of MAS may need to be reevaluated in a study with a larger sample size. Ann Thorac Surg, 2004 Oct, 78(4), e65 - 6 Aneurysm of the mitral valve: a rare complication of aortic valve endocarditis; Halkos ME et al.; A 45-year-old man presented to our hospital with severe dyspnea 4 months after antibiotic treatment for aortic valve endocarditis . Transesophageal echocardiography revealed severe aortic regurgitation and an aneurysm of the anterior leaflet of the mitral valve . In addition to aortic valve replacement, we excised the aneurysm and repaired the anterior leaflet of the mitral valve . Clinical suspicion, appropriate preoperative imaging, and timely surgical intervention are essential to recognize and treat this rare complication of bacterial endocarditis. Nucl Med Biol, 2004 Oct, 31(7), 875 - 82 Influence of ceftriaxone treatment on FDG uptake--an in vivo {18F}-fluorodeoxyglucose imaging study in soft tissue infections in rats; Wyss MT et al.; Our aim was to determine the influence of antibiotic treatment using ceftriaxone on {18F}-fluorodeoxyglucose (FDG) uptake in experimental soft tissue infections . PET scans were performed in two groups (treated n=4; non-treated n=4) at days 3, 5, and 6 after inoculation of the infection . Additional autoradiography was performed in four animals at day 7 and in three animals at day 11 . The difference of FDG uptake on day 5 (after three days of antibiotic treatment) between both groups proved to be significant (df=6; T=2.52; p=0.045) . FDG uptake determined at the other days did not reveal significant difference between the two groups . It seems to be possible that the effect of antibiotic treatment on FDG uptake is less evident than reported for therapy monitoring of cancer treatment . The change of FDG uptake over time in treated and untreated infections is complex and further in vivo experiments have to be initiated to investigate the potential value of clinical FDG PET in therapy monitoring of infection. Eur J Epidemiol, 2004, 19(7), 703 - 5 Antibiotic treatment for influenza does not affect resolution of illness, secondary visits or lost workdays; Carrat F et al.; Antibiotics are common prescribed against influenza, although no trials of their efficacy have been published . We compared clinical and societal outcomes in 701 patients (56% flu-positive) according to use of antibiotics . The median duration of illness, rate of secondary visits, and lost workdays did not differ between antibiotic and non-antibiotic treated patients . Antibiotics are unnecessary expenses in the initial treatment of influenza, as they can give potential side-effects and contribute to spread of antibiotic-resistant bacteria. J Clin Oncol, 2004 Oct 1, 22(19), 3922 - 9 Inpatient versus outpatient management of low-risk pediatric febrile neutropenia: measuring parents' and healthcare professionals' preferences; Sung L et al.; PURPOSE: Our primary objective was to describe and compare parents' and healthcare professionals' strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment for low-risk febrile neutropenic children . Our secondary objective was to identify predictors of strength of preference for oral outpatient treatment . METHODS: Respondents were parents of children receiving cancer chemotherapy, and pediatric oncology healthcare professionals . First, the inpatient and outpatient options were described, and the respondent indicated their initially preferred option . The respondent next ranked how important seven factors (including "fear/anxiety" and "comfort") were in making their initial choice . The threshold technique was then used to elicit the respondent's strength of preference score for oral outpatient, relative to parenteral inpatient management . RESULTS: There were 75 parent and 42 healthcare-professional respondents . There was no significant difference (P =.08) in the proportions of parents (40 of 75; 53%) and healthcare professionals (30 of 42; 71%) who initially would choose outpatient management . For parents, stronger preference for oral outpatient therapy was associated with higher anticipated quality of life for the parent and child at home relative to hospital, lower importance rank for "fear/anxiety," and higher importance rank for "comfort." Conversely, for professionals, only lower importance rank for "fear/anxiety" was associated with higher strength of preference scores for outpatient oral antibiotic management . CONCLUSION: Only 53% of parents would choose outpatient oral antibiotic management for low-risk febrile neutropenia . Predictors of strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment differed between parent and professional respondents. Eur Respir J, 2004 Oct, 24(4), 644 - 8 Cost-effectiveness of full-course oral levofloxacin in severe community-acquired pneumonia; Wasserfallen JB et al.; Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumonia (CAP) . The current authors assessed whether oral levofloxacin treatment of patients with severe CAP, followed-up for 30 days, would save money . Over a 12-month period, 129 hospitalised patients with severe non-intensive care unit CAP were randomly assigned to receive either oral levofloxacin or sequential antibiotic treatment . Direct and indirect costs were compared over a 30-day period from several perspectives . CAP resolved in 71 out of 77 oral levofloxacin (92%) and in 34 out of 37 sequential antibiotic treatment patients (92%) . Patients' characteristics, treatment duration, hospital length of stay and mortality were similar in both groups . Drug acquisition costs were 1.7-times smaller in oral levofloxacin patients, who were less often transferred to rehabilitation centres, but they used more physicians' visits during follow-up and their total costs were lower . As only a minority of patients was still active, inability to work and, hence, indirect costs were similar in both groups . In this study, oral levofloxacin for severe non-intensive care unit community-acquired pneumonia was equally effective as sequential antibiotic treatment, but did not lead to major costs savings except for drug acquisition costs . External factors linked with patients' characteristics and/or medical practice are likely to play a role and should be addressed. An Pediatr (Barc), 2004 Oct, 61(4), 298 - 304 {Antibiotic use in primary care . Do we know what parents think?}; Bunuel Alvarez JC et al.; INTRODUCTION: In Spain, studies that investigate parents' beliefs on antibiotic use are lacking . Mistaken beliefs lead to inappropriate antibiotic use and encourage overuse . The aim of the present study was to determine parents' knowledge about antibiotic use . MATERIAL AND METHODS: We performed a cross sectional, descriptive study in two health centers through a self-administered questionnaire completed by 348 parents . The response variable consisted of beliefs evaluated when the parents answered the following three statements in the affirmative: a) there are currently some infections with inadequate response to antibiotic treatment; b) if antibiotics are used too often, they can cease to have an effect; c) if your child frequently receives antibiotic treatment, subsequent use may have no effect . Independent variables consisted of sex of the responder, educational level, parental age and ethnicity, attendance at school (public or private), attendance at kindergarten, usual healthcare (public-private), and number of siblings . Statistical analysis consisted of logistic regression . RESULTS: A total of 31.6 % (95 % CI: 26.7-36.5) responded affirmatively to the three statements . Adequate knowledge was associated with the non-immigrant population (OR: 5.7; 95 % CI: 1.37-24.9) and high parental education