Antibiotic treatment

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 (OR: 2.04; 95 % CI: 1.16-3.06) . CONCLUSIONS: Parents' knowledge of antibiotic use is low compared with that in other countries . Health education programs to remedy this situation are urgently required.

Rev Neurol (Paris), 2004 Sep, 160(8-9), 833 - 5
{Ataxic sensory neuropathy and Lyme disease}; Thouvenot E et al.; INTRODUCTION: The clinical spectrum of peripheral neuropathies in Lyme disease is very wide . We report a case which was revealed by an ataxic sensory neuropathy . OBSERVATION: A 77-year-old patient presented with a subacute ataxic sensory neuropathy which occurred 2 weeks after a skin lesion involving the right lower limb . He fully recovered after specific antibiotic treatment . EMG was suggestive of a predominantly axonal neuropathy . Diagnosis of Lyme disease was assessed by progressive elevation of serum antibodies, demonstration of a lymphocytic meningitis and intrathecal synthesis of antibodies . CONCLUSION: Lyme disease may be added to the list of diseases which may induce subacute sensory neuropathies.

Adolesc Med Clin, 2004 Jun, 15(2), 253 - 71
Urethritis and cervicitis in adolescents; Simpson T et al.; Sexually acquired lower-genitourinary tract infections are a significant source of morbidity for adolescents . Causative organisms include T . vaginalis, Mycoplasma organisms, Ureaplasma organisms, and, most commonly, N . gonorrhoeae and C . trachomatis . With NAATs, noninvasive screening can be accomplished easily . The importance of screening in high-risk populations cannot be overemphasized, especially because these infections are often asymptomatic . The treatment of sexually transmitted bacterial infections includes appropriate antibiotic treatment for the presenting patient, partner identification and treatment, and counseling to prevent reinfection.

Ann Acad Med Singapore, 2004 Jul, 33(4 Suppl), 77 - 9
Case report of a dermoid cyst at the floor of the mouth; Seah TE et al.; The growth of dermoid cysts at the floor of the mouth is considered a rare condition . Typically, intra-oral dermoid cysts present as non-tender, slow growing masses at the sublingual, submental and submandibular region . We report a case of a young adult male who presented at our hospital with a sublingual cyst superimposed with acute infection and failed antibiotic treatment . The cyst was excised and confirmed histopathologically as a dermoid cyst with overlying acute inflammation . Clinical progress was uneventful and postoperative recovery excellent with no recurrence.

Gastroenterol Hepatol, 2004 Oct, 27(8), 464 - 6
{Primary hepatic actinomycosis}; Castellon Pavon CJ et al.; Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes . We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma . After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe . Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy . Prolonged antibiotic treatment produced a complete response . The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.

Rev Clin Esp, 2004 Sep, 204(9), 466 - 71
{Effect of immunomodulator AM3 on the exacerbations in patients with chronic bronchitis: a systematic review of controlled trials}; Reyes Martin E et al.; OBJECTIVE: Analyze the effect of AM3, an oral immunomodulator, on the exacerbations and on the use of antibiotics in patients with chronic obstructive pulmonary disease (COPD) . DESIGN: Systematic search of controlled clinical trials that used AM3 in some treatment group and that included data on the clinical effects of this drug on patients with COPD . SELECTED VARIABLES: Nine studies were detected in which the clinical effectiveness of AM3 was evaluated in relation to the number of infectious exacerbations, their length, and the length of the antibiotic treatment used . RESULTS: In comparison with placebo group, the average number of excaerbations suffered by the patients treated with AM3 declined significantly in 0.31 units (p < 0.001; 95% confidence interval: 0.20-0.42), without heterogeneity among the different studies (Q = 6.62; p > 0.43) . With regard to the average length of the exacerbations and the average length of the antibiotic treatment used for the exacerbations, both variables declined significantly in the group treated with AM3 (3.10 days, p < 0.001, and 8.07 days, p < 0.001, respectively) but this positive effect could not be confirmed because trials were close to heterogeneity . CONCLUSIONS: The results of this systematic review show that AM3 has a clinical effect in the prevention of exacerbations of COPD patients because reduces significantly their number . This could be related to a slowing in the progression of the deterioration in the respiratory function with a potential impact on the quality of life of the patients . Furthermore, these data imply a positive therapeutic result and a possible decline in development of bacterial resistances secondary to the frequent and indiscriminate use of antibiotics in these patients.

Korean J Hepatol, 2004 Sep, 10(3), 207 - 15
{Changes of ascites nitric oxide according to the treatment course in cirrhotic patients with spontaneous bacterial peritonitis}; Park YS et al.; BACKGROUND/AIMS: Nitric oxide (NO) is a molecule involved in vascular dilatation and pathogen suppression . It also has immunologic and regulatory functions . Liver cirrhosis is characterized by an increased risk for bacterial infections, including spontaneous bacterial peritonitis (SBP) . The role of NO in SBP which develops in cirrhosis has not been clearly established . The aim of this study was to investigate the role of NO in the pathogenesis of SBP and its clinical usefulness for prediction of disease prognosis . METHODS: This study was designed to investigate the changes of ascites NO in the course of treatment . Nitric oxide metabolite (nitrites+nitrates {NOx}) was measured by chemiluminescence in 84 ascites samples obtained from 84 cirrhotic patients . Among them, the 38 patients with SBP were treated with cefotaxime 2.0 g, q 12hr for 7 days . In 24 of SBP patients, ascites was obtained consecutively before treatment (day 0), during treatment (day 2), and after treatment (day 7) . RESULTS: Ascites NO levels in the patients with SBP (n=38; 82.3 +/- 14.4 microM) were not different from those in patients with sterile ascites (n=46; 54.6 +/- 13.0 microM) . There was no significant change of NO levels in sequential ascites samples during antibiotic treatment . Ascites NO level before treatment was significantly higher in SBP patients who responded to antibiotics (n=26; 101.86 microM/L) than that in SBP patients who did not respond to antibiotics (n=12; 40.03 microM/L, P=0.044) . A significant direct correlation was found between ascites and serum NO levels before treatment (Pearson correlation, r2=0.86, P=0.001) . Among the SBP patients, treatment response rate to antibiotics were significantly higher in those patients with pretreatment NO level > or = 80 microM/L in multivariate analysis . CONCLUSIONS: Ascites NO level was not different between ascites from SBP patients and ascites from cirrhotic patients with sterile ascites . There were no changes of ascites NO in SBP patients during treatment . Therefore ascites NO was not useful to predict the progress of SBP . Ascites NO levels reflect serum NO levels, and the patients with higher NO level may have better response to antibiotics.

Infect Immun, 2004 Oct, 72(10), 5687 - 92
Wolbachia-induced neutrophil activation in a mouse model of ocular onchocerciasis (river blindness); Gillette-Ferguson I et al.; Endosymbiotic Wolbachia bacteria are abundant in the filarial nematodes that cause onchocerciasis (river blindness), including the larvae (microfilariae) that migrate into the cornea . Using a mouse model of ocular onchocerciasis, we recently demonstrated that it is these endosymbiotic bacteria rather than the nematodes per se that induce neutrophil infiltration to the corneal stroma and loss of corneal clarity (Saint Andre et al., Science 295:1892-1895, 2002) . To better understand the role of Wolbachia organisms in the pathogenesis of this disease, we examined the fate of these bacteria in the cornea by immunoelectron microscopy . Microfilariae harboring Wolbachia organisms were injected into mouse corneas, and bacteria were detected with antibody to Wolbachia surface protein . Within 18 h of injection, neutrophils completely surrounded the nematodes and were in close proximity to Wolbachia organisms . Wolbachia surface protein labeling was also prominent in neutrophil phagosomes, indicating neutrophil ingestion of Wolbachia organisms . Furthermore, the presence of numerous electron-dense granules around the phagosomes indicated that neutrophils were activated . To determine if Wolbachia organisms directly activate neutrophils, peritoneal neutrophils were incubated with either parasite extracts containing Wolbachia organisms, parasite extracts depleted of Wolbachia organisms (by antibiotic treatment of worms), or Wolbachia organisms isolated from filarial nematodes . After 18 h of incubation, we found that isolated Wolbachia organisms stimulated production of tumor necrosis factor alpha and CXC chemokines macrophage inflammatory protein 2 and KC by neutrophils in a dose-dependent manner . Similarly, these cytokines were induced by filarial extracts containing Wolbachia organisms but not by Wolbachia-depleted extracts . Taken together, these findings indicate that neutrophil activation is an important mechanism by which Wolbachia organisms contribute to the pathogenesis of ocular onchocerciasis.

Ocul Immunol Inflamm, 2004 Sep, 12(3), 227 - 31
Branch retinal arterial occlusion associated with toxoplasmic chorioretinitis; Kucukerdonmez C et al.; BACKGROUND: Ocular toxoplasmosis can cause a variety of retinal vascular changes including branch retinal arterial occlusion, which is a rare complication of the disease . PATIENT AND METHODS: We report a case of toxoplasmic chorioretinitis in a pregnant woman, who developed branch retinal arterial obstruction adjacent to the active chorioretinitis lesion . RESULTS: The patient received an appropriate steroid and antibiotic treatment and the retinitis lesion resolved over a six-week period . At two months after diagnosis, visual acuity in her right eye was 20/30 and there was a hyperpigmented scar at the site where active retinitis had been observed . CONCLUSION: Especially in young patients with branch retinal vascular occlusion associated with posterior uveitis, the diagnosis of ocular toxoplasmosis should be kept in mind and serologic test results should be obtained.

Proteomics, 2004 Oct, 4(10), 2969 - 81
Action and reaction: Chlamydophila pneumoniae proteome alteration in a persistent infection induced by iron deficiency; Wehrl W et al.; Chlamydophila pneumoniae is an obligate intracellular pathogen implicated in a variety of acute and chronic diseases . Long-term infections are associated with a persistent life stage, in which bacteria can stay for years . They are less accessible to antibiotic treatment but still prone to sustain an inflammatory response . Different in vitro models have been established to mimic and characterize chlamydial persistency . For C . pneumoniae and Chlamydia trachomatis, altered metabolic activities and changed antigenic profiles compared to acute infections have been reported . Most studies including transcriptome and proteome analyses describe persistency induced by IFNgamma treatment . Here, we use iron depletion of the infected cell culture that also leads into persistent infection . We describe differently regulated proteins found by subtractive proteome analysis comparing two early stages of infection with and without addition of the iron chelator deferoxamine-mesylate . While only one bacterial protein was up-regulated during iron deficiency up to 24 h post infection (p.i.), 11 were found to be up-regulated and eight to be down-regulated from 24-48 h p.i . Two down-regulated proteins could be identified by peptide mass fingerprinting as thioredoxin reductase and chromosome partitioning protein (ParB) . The latter is involved in chromosome segregation . Thus, using a comparative approach we identified on a proteome level down-regulation of ParB in persistent chlamydial forms, which is in agreement with previous results describing changes in cell division and atypical altered morphology of persistent Chlamydiae.

Curr Opin Otolaryngol Head Neck Surg, 2004 Oct, 12(5), 418 - 25
Sensory hair cell death and regeneration: two halves of the same equation; Matsui JI et al.; PURPOSE OF REVIEW: Sensory hair cells are susceptible to ototoxic damage from a variety of sources, including antibiotic treatment . Unfortunately, this often results in permanent hearing and/or balance problems in humans . By understanding how sensory hair cells die in response to aminoglycoside treatment, preventive strategies may be developed . This review will discuss some of the key recent findings in sensory hair cell death and regeneration . RECENT FINDINGS: Aminoglycosides induce hair cell death through the initiation of apoptosis . Early and late stages of hair cell apoptosis have been defined, and several of the key molecules involved in the cascade have been identified . Moreover, specific inhibitors of apoptosis rescue hair cells from death and preserve function . Hair cell death has been shown to induce regeneration through supporting cell transdifferentiation, proliferation, and new hair cell differentiation in birds and lower vertebrates . Regeneration in the mammalian cochlea does not occur spontaneously, but genetic manipulation of cell cycle genes, induction of new hair cells through gene therapy, and introduction of stem cells into damaged cochleas suggest that repair and replacement of lost hair cells in the organ of Corti may be possible . Finally, continuing investigations of the mouse, zebrafish, and human genomes may one day enable manipulation of the cochlea so that functional regeneration is readily available as a therapeutic intervention . SUMMARY: The discovery that hair cells can regenerate in birds and other nonmammalian vertebrates has fueled a wide range of studies to find ways to restore hearing and balance in mammals . The demonstration that apoptosis and proliferation are coupled as controlling factors in regeneration and the advent of new approaches such as gene therapy, stem cell transplantation, and genomics may lead to methods for inducing hair cell regeneration and repair in the mammalian cochlear and vestibular systems.

An Med Interna, 2004 Aug, 21(8), 397 - 9
{Extragonadal germ cell tumor in HIV+ female}; Fuentes Garcia MI et al.; Extragodanal germ cell tumors (EGCT) are not common, especially among women . Although there is no evidence of relationship between this sort of tumor and HIV infection they can appear at the same time in a patient, because in both cases the maximum incidence occurs in patients in the same age group . We present the case of a 27 years old woman, poly-drug user, with a recently diagnosis of HIV infection, who was admitted to clinic because of infection and shortage of breath, and develops during her hospitalization diarrhoea, generalized tonic-clonic seizure and left hemiparesis . Complementary tests showed us diffuse interstitial pulmonary pattern, mediastinal mass with intrathoracic adenopathies, cerebral tumor and diffuse intestinal enlargement . The breath infection got better with a wide-ranging antibiotic treatment, which included cotrimoxazol and levofloxacin, but the brain tumor didnt get better with the antitoxoplasma treatment . The clinical presentation simulated in the beginning a disseminated lymphoma, in a HIV+ patient; nevertheless, after receiving the result of the biopsy of a supraclavicular adenopathy and a b-HCG, an extragodanal germ cell tumor was diagnosed . We haven't found any case of EGCT in young women infected with HIV in our bibliographical review (MEDLINE).

Pediatr Res, 2004 Nov, 56(5), 796 - 803 Epub 2004 Sep 15.
Neutrophil CD64 is a sensitive diagnostic marker for early-onset neonatal infection; Ng PC et al.; This prospective study aimed to evaluate the diagnostic utilities of neutrophil CD64 expression for the identification of early-onset clinical infection and pneumonia in term infants and to define the optimal cutoff value so that it may act as a reference with which future studies can be compared . Term newborns in whom infection was suspected when they were <72 h of age were recruited into the study . C-reactive protein (CRP) and expression of CD64 on neutrophils were measured at 0 h (at the time of sepsis evaluation) and 24 h . The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of CRP, CD64, and the combination of these two markers for predicting neonatal sepsis were determined . A total of 338 infants with suspected clinical sepsis were investigated, 115 of whom were found to be clinically infected . CRP and CD64 in infected infants were both significantly elevated at 0 and 24 h compared with noninfected infants (p < 0.001) . The calculated optimal cutoff value for CD64 was 6136 antibody-phycoerythrin molecules bound/cell . CD64 has a very high sensitivity (96%) and NPV (97%) at 24 h . The addition of CRP only marginally enhanced the sensitivity and NPV (97 and 98%, respectively) . In conclusion, neutrophil CD64 is a very sensitive diagnostic marker for the identification of early-onset clinical infection and pneumonia in term newborns . The results strongly suggest that measurement of neutrophil CD64 may allow neonatal clinicians to discontinue antibiotic treatment at 24 h in infants who are clinically stable and whose CD64 expressions are below the optimal cutoff level.

Dtsch Med Wochenschr, 2004 Sep 3, 129(36), 1858 - 60
{Chronic eosinophilic pneumonia}; Voss M et al.; HISTORY AND ADMISSION FINDINGS: A 43-year-old woman (patient 1) and a 58-year-old man (patient 2) presented with fever, nocturnal perspiration, dry cough, dyspnoea and general weakness . These symptoms had been present for several months . Repeated courses of antibiotic treatment as outpatients had failed . On admission their general condition was unremarkable . INVESTIGATIONS: The differential blood count revealed marked eosinophilia of 35% and 27%, respectively, and raised infection parameters . Results of laboratory tests were unremarkable . Conventional radiological films and CT of the thorax showed infiltrates, especially in the periphery . In both patients bronchoscopy revealed moderately severe bronchitis . Broncho-alveolar lavage and the peripheral blood count showed marked eosinophilia of 61% and 54%, respectively . Biopsies did not reveal necrosis, fungal infection, parasites, granulomas or vasculitis . DIAGNOSIS, TREATMENT AND COURSE: The described findings indicated a chronic eosinophilic pneumonia (CEP) in both patients . Treatment was initiated with high steroid dosage, namely 60 mg prednisolone equivalent daily, gradually reducing with improvement . The symptoms rapidly lessened and the radiological changes regressed after ca . 14 days . Intermittent recurrences were noted in both patients on reduction or termination, respectively, of the steroid treatment which had lasted for several months . CONCLUSIONS: CEP is an important disease to be considered in the differential diagnosis of unclear pulmonary infiltrates associated with an increased eosinophilia in both peripheral blood and the lungs . In some cases it may be necessary to continue steroid treatment over long periods, even years, to bring the pulmonary changes of CEP under control.

Orv Hetil, 2004 Jul 11, 145(28), 1451 - 7
{Prophylactic antibiotic treatment of neutropenic patients}; Telekes A et al.; There is no special signs of neutropenia therefore it is usually diagnosed due to an acute infection or laboratory control . Infections acquired during chemotherapy induced myelosuppression may further deteriorate the neutropenia in cancer patients . There are many possible cause of fever in cancer patients but in case of neutropenia infection is the most likely reason . If febrile neutropenia occurs immediately broad spectrum intravenous antibiotic treatment should be initiated . Recently introduced aggressive chemotherapy protocols further increased the number of neutropenic patients . Therefore it would be important to prevent febrile neutropenia . Unfortunately the available data still insufficient to make any conclusions regarding the efficacy of short or long term prophylactic treatment . While there are generally accepted recommendations of empiric antibiotic therapy no such options are available regarding prophylactic treatments . The decision regarding prophylactic treatment (similarly to empiric therapy) should be based on the resistance of the dominant pathogens in a therapeutic unit . Several study had been conducted regarding prophylactic administration of antibiotics the results however contradictory . Considering the advantages and disadvantages, the prophylactic antibiotic treatment of neutropenic patients could be suggested only in certain cases.

Monaldi Arch Chest Dis, 2004 Jan-Mar, 61(1), 39 - 43
Bronchoalveolar lavage in intensive care units; Pesci A et al.; Pneumonia is common in those patients placed in intensive care units, especially in mechanically ventilated patients . The high mortality rate of ventilator-associated pneumonia requires a rapid initiation of the appropriate antibiotic treatment . Patients who do not respond to initial antibiotic regimens could have the additional benefit of the use of invasive techniques such as bronchoalveolar lavage . Moreover, BAL is of clinical use to identify several non-infectious pulmonary conditions that may mimic pneumonia in these patients . Such conditions include pulmonary haemorrhages, acute eosinophilic pneumonia, malignancy, drug-induced toxicity, adult respiratory distress syndrome and cardiogenic pulmonary oedema . It is important to distinguish these conditions from pneumonia because the management and prognosis of these entities is quite different.

J Nephrol, 2004 May-Jun, 17(3), 427 - 30
The value of low-dose intraperitoneal immunoglobulin administration in the treatment of peritoneal dialysis-related peritonitis; Coban E et al.; BACKGROUND: Peritonitis is a major complication of continuous ambulatory peritoneal dialysis (CAPD) . The value of immunomodulatory therapeutic approaches and, especially, methods aimed at augmenting opsonization in the treatment of peritoneal dialysis (PD)-related peritonitis is unclear . In this study, the effect of intraperitoneal (IP) immunoglobulin (Ig) usage, as an approach for strengthening opsonization, was evaluated in CAPD peritonitis . METHODS: The study included 24 patients with CAPD peritonitis . The patients were divided into two groups, A and B, each consisting of 12 patients . There were no significant differences between the groups in terms of age, gender, CAPD duration, and peritonitis rate . Empiric antibiotic treatment was a 2-week IP ampicillin+sulbactam/netilmycin combination . Group B was additionally given low-dose IP IgG (2 mL = 320 mg) with every exchange . The dialysate leucocyte counts were obtained in both groups until the number was <100 cells/microL to monitor the response to peritonitis treatment . RESULTS: In group A, the number of exchanges done until the dialysate leucocyte counts decreased to <100/mL was 13.9 +/- 1.4 and for group B 6.6 +/- 0.4 (p<0.001) . The reduction in neutrophils was significantly faster in group B compared to group A (p<0.001) . The number of exchanges until abdominal pain completely disappeared was 12.5 +/- 1.7 in group A and 5.6 +/- 0.7 in group B (p<0.001) . CONCLUSIONS: The results of this study show that low-dose, continuous IP IgG administration in the treatment of PD-related peritonitis is safe and effective in shortening the treatment time.

Skinmed, 2004 Sep-Oct, 3(5), 274 - 8
Klinefelter's syndrome presenting with leg ulcers; De Morentin HM et al.; A 54-year-old man of Persian origin presented to our department with a 1-year history of ulcers on the right leg that had been unresponsive to numerous topical treatments, accompanied by lymphedema of the right leg . Medical history included hypergonadotropic hypogonadism, which had not been further investigated . He was treated for 20 years with testosterone IM once monthly, which he stopped a year before the current hospitalization for unclear reasons . The patient reported no congenital lymphedema . Physical examination revealed two deep skin ulcers (Figure 1) on the right leg measuring 10 cm in diameter with raised irregular inflammatory borders and a boggy, necrotic base discharging a purulent hemorrhagic exudate . Bilateral leg pitting edema and right lymphangitis with lymphadenitis were noted . He had low head hair implantment, sparse hair on the body and head, hyperpigmentation on both legs, onychodystrophia of the toenails (mainly the large toe and less prominent on the other toes), which was atrophic lichen-planus-like in appearance and needed no trimming (Figure 2), normal hand nails, oral thrush, and angular cheilitis . Other physical findings were gynecomastia, pectus excavatum, small and firm testicles, long extremities, asymmetrical goiter, systolic murmur 2/6 in left sternal border, and slow and inappropriate behavior . The patient's temperature on admission was 39 degrees C . Blood cultures were negative for bacterial growth . Results of laboratory investigations included hemoglobin (11.2 g/dL), hematocrit (26.8%), normal mean corpuscular volume and mean corpuscular hemoglobin volume, and red blood cell distribution width (16%) . Blood smear showed spherocytes, slight hypochromia, anisocytosis, macrocytosis, and microcytosis . Blood chemistry values were taken for iron (4 micro g/dL {normal range 40-150 micro g/dL}), transferrin (193 mg/dL {normal range 220-400 mg/dL}), ferritin (1128 ng/mL {normal range 14-160 ng/mL}), transferrin saturation (1.5% {normal range 20%-55%}), serum folate (within normal limits), and vitamin B12 (within normal limits) . Direct Coombs' test equaled positive 2 + IgG . All these values indicated anemia of chronic diseases combined with hemolytic anemia . Further blood work-up tested antinuclear antibody (positive <1:80 homogeneous pattern), rheumatoid factors (143 IU/mL {positive >8.5 IU/mL}), C-reactive protein (286 mg/L {normal range 0-5 mg/L}), anticardiolipin IgM antibody (9.0 monophosphoryl lipid U/mL {normal range 0-7.00 MPL U/mL}) and antithrombin III activity (135% {normal range 74%-114%}) . Results of other blood tests were within normal limits or negative, including lupus anticoagulant, beta2 glycoprotein, anticardiolipin IgG Ab, anti-ss DNA Ab, C3, C4, anti-RO, anti-LA, anti-SC-70, anti-SM Ab, P-ANCA, C-ANCA, TSH, FT4, anti-T microsomal, antithyroglobulin, protein C activity, protein S free, cryoglobulins, serum immunoelectrophoresis, VDRL, hepatitis C antibodies, hepatitis B antigen, and human immunodeficiency virus . Endocrinological work-up examined luteinizing hormone (22.9 mIU/mL {normal range for adult men 0.8-6 mIU/mL}), follicle stimulating hormone (49.7 mIU/mL {normal range for adult men 1-11 mIU/mL}), testosterone (0.24 ng/mL {normal range for adult men 2.5-8.0 ng/mL}), bioavailable testosterone (0.02 ng/mL {normal range for adult men >0.6 ng/mL}), and percent bioavailable test (8.1% {normal value >20%}) . These results indicate hypergonadotropic hypogonadism . Plasminogen activator inhibitor 1 was 6 U (normal value 5-20 U/mL) . Karyotyping performed by G-banding technique revealed a 47 XXY karyotype, which is diagnostic of Klinefelter's syndrome . Doppler ultrasound of the leg ulcers disclosed partial thrombus in the distal right femoral vein . X-rays and bone scan displayed osteomyelitis along the right tibia . Histological examination of a 4-mm punch biopsy from the ulcer border revealed hyperkeratosis, acanthosis, hypergranulosis, and mixed inflammatory infiltrate containing eosinophils compatible with chronic ulcer . Multiple vessels were seen, compatible with a healing process . Direct immunofluorescence of the biopsy revealed granular IgM in the dermo-epidermal junction . Indirect immunofluorescence was negative . Thyroid function tests showed normal thyroid stimulating hormone and free throxine4 . Multinodular goiter was seen on thyroid scan and ultrasound . Thyroid fine needle aspiration was compatible with multinodular goiter (normal follicular cells, free colloid, macrophages with pigment) . IV treatment with amoxicillin-clavulanic acid 1 g t.i.d . was administered for 2 weeks, with a decrease in temperature and normalization of the leukocyte level . Oral antibiotic treatment with amoxicillin-clavulanic acid was continued for 10 more days, followed by 25 days of ciprofloxacin for the osteomyelitis . Local treatment included saline soakings followed by application of Promogran (Johnson & Johnson, New Brunswick, NJ) and Kaltostat (ConvaTec Ltd., a Bristol-Myers Squibb Company, New York, NY) with slight improvement . At the same time, the patient was treated with warfarin sodium due to deep vein thrombosis under international normalized ratio 2-3 . The patient was treated with IM testosterone once monthly for 1 year, which resulted in a reduction in the diameter and depth of the leg ulcers (Figure 3) . Blood tests were not performed for follow-up of the immune state.

Am J Ophthalmol, 2004 Sep, 138(3), 506 - 7
Deep anterior lamellar keratoplasty in a patient with descemetocele following gonococcal keratitis; Tong L et al.; PURPOSE: To describe the presentation and subsequent management of a case of severe gonococcal keratitis in a young man . DESIGN: Case report . METHODS: A young man presented with severe gonococcal keratitis . Topical and systemic antibiotics were given with no improvement, and progressive corneal melting was noted . Deep lamellar keratoplasty was performed . The clarity and state of corneal graft and the postoperative visual acuity were noted . RESULTS: At 6 months posttreatment, the graft was clear, and no recurrence of infection was noticed . Corrected visual acuity was 20/25 . CONCLUSION: Deep lamellar keratoplasty should be considered as a therapeutic option in patients with severe gonococcal keratitis that does not respond to antibiotic treatment.

J Peripher Nerv Syst, 2004 Sep, 9(3), 165 - 7
Neuropathy and cognitive impairment following vaccination with the OspA protein of Borrelia burgdorferi; Latov N et al.; Neurological syndromes that follow vaccination or infection are often attributed to autoimmune mechanisms . We report six patients who developed neuropathy or cognitive impairment, within several days to 2 months, following vaccination with the OspA antigen of Borrelia burgdorferi . Two of the patients developed cognitive impairment, one chronic inflammatory demyelinating polyneuropathy (CIDP), one multifocal motor neuropathy, one both cognitive impairment and CIDP, and one cognitive impairment and sensory axonal neuropathy . The patients with cognitive impairment had T2 hyperintense white matter lesions on magnetic resonance imaging . The similarity between the neurological sequelae observed in the OspA-vaccinated patients and those with chronic Lyme disease suggests a possible role for immune mechanisms in some of the manifestations of chronic Lyme disease that are resistant to antibiotic treatment.

BMC Evol Biol . 2004 Sep 09;4(1):31.
Evidence for positive selection on Mycobacterium tuberculosis within patients; Tanaka MM; BACKGROUND: While the pathogenesis and epidemiology of tuberculosis are well studied, relatively little is known about the evolution of the infectious agent Mycobacterium tuberculosis, especially at the within-host level . The insertion sequence IS6110 is a genetic marker that is widely used to track the transmission of tuberculosis between individuals . This and other markers may also facilitate our understanding of the disease within patients . RESULTS: This article presents three lines of evidence supporting the action of positive selection on M . tuberculosis within patients . The arguments are based on a comparison between empirical findings from molecular epidemiology, and population genetic models of evolution . Under the hypothesis of neutrality of genotypes, 1) the mutation rate of the marker IS6110 is unusually high, 2) the time it takes for substitutions to occur within patients is too short, and 3) the amount of polymorphism within patients is too low . CONCLUSIONS: Empirical observations are explained by the action of positive selection during infection, or alternatively by very low effective population sizes . I discuss the possible roles of antibiotic treatment, the host immune system and extrapulmonary dissemination in creating opportunities for positive selection.

Int J Colorectal Dis, 2005 Jan, 20(1), 24 - 7 Epub 2004 Sep 04.
Surgical management of cecal diverticulitis: is diverticulectomy enough?
Papaziogas B, Makris J, Koutelidakis I, Paraskevas G, Oikonomou B, Papadopoulos E, Atmatzidis K.
INTRODUCTION: Cecal diverticulitis is a rare condition in the western population . The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection . We present our experience of the surgical management of eight cases of cecal diverticulitis over a 25-year period.PATIENTS AND METHODS: The mean age of the patients was 54.2 years . Five patients underwent diverticulectomy, 2 patients underwent ileocecal resection, and 1 patient underwent suture of the perforated diverticulum.RESULTS: The postoperative course of all patients was uneventful . At long-term follow-up (mean 14.6 years, range 1-25 years) none of the patients who underwent diverticulectomy, mentioned any symptom or complication.CONCLUSION: We conclude that diverticulectomy, if technically feasible, could be considered as adequate therapy for cecal diverticulitis . Aggressive resection should be considered in cases of extensive inflammatory changes.

Australas Radiol, 2004 Sep, 48(3), 318 - 23
Computed tomography evaluation of cavitary necrosis in complicated childhood pneumonia; Kosucu P et al.; The purpose of the present study was to retrospectively investigate the chest radiograph (CR) and CT findings of childhood pneumonia complicated by cavitary necrosis, and to evaluate the role of CT in decision-making for surgical intervention . Chest CT was performed in 51 patients presenting with persistent or progressive pneumonia, respiratory distress and sepsis despite 7-10 days of appropriate antibiotic treatment and closed tube drainage . Chest radiograph and CT findings were retrospectively evaluated in 23 patients (45%) with cavitary necrosis . Chest radiographs showed consolidation in 19 of 23 patients, cavitation in five patients, parapneumonic effusions in 17 patients and air-fluid levels in the pleural space in one patient . The CT scans demonstrated consolidation and cavitary necrosis in all patients . There were parapneumonic effusions in all patients with concomitant loculated collections in six patients . Twenty-two of 23 patients had pleural thickening . In seven patients there were air-fluid levels in the pleural space . In five of these patients, CT scans demonstrated bronchopleural fistulae . On the basis of the CT and clinical findings, 11 patients underwent surgical intervention . Computed tomography is superior to CR for demonstrating cavitary necrosis complicating pneumonia, and other parenchymal and pleural complications . It also has a crucial decision-making role for surgery.

Hautarzt, 2004 Oct, 55(10), 997 - 9
{Treatment-resistant granulomatous rosacea-like dermatitis in a 9-year-old girl}; Poblete-Gutierrez P et al.; A 9-year-old female developed facial papules and pustules since four years . Clinically, perioral dermatitis was suspected . Different topical therapy regimens and systemic anibiotics had been unsuccessful and a skin biopsy showed granulomatous (lupoid) rosacea . Only systemic antibiotic treatment with minocyclin led to healing of the skin lesions . While granulomatous rosacea-like dermatitis is more frequently diagnosed in adults, it is only rarely encountered in children where, in most of the cases, it represents a therapeutic challenge.

Arch Pathol Lab Med, 2004 Sep, 128(9), 1035 - 8
One patient, two lymphomas . Simultaneous primary gastric marginal zone lymphoma and primary duodenal follicular lymphoma; Tang Z et al.; We report the case of a 73-year-old man who presented with a 2- to 3-month history of epigastric discomfort and guaiac-positive stool . An upper gastrointestinal endoscopy revealed a diffuse erythematous nodular mucosa and submucosal thickening in the stomach . Diffuse mucosal nodularity was also found in the second portion of the duodenum . A complete workup with histologic, immunohistochemical, and molecular studies revealed 2 distinct, apparently unrelated lymphomas, namely, a gastric marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue type) in a background of Helicobacter pylori gastritis and a grade 1/3 duodenal follicular lymphoma . The patient was then treated with an H pylori eradication regimen . No therapy was given for his duodenal follicular lymphoma because his symptoms were thought to be due to the gastric disease and because the duodenal lesion was small . A 6-month follow-up with upper gastrointestinal endoscopy revealed only focal biopsy scarring in the stomach and an apparently normal duodenum . The follow-up biopsies revealed significant regression of his mucosa-associated lymphoid tissue lymphoma, but persistence of his duodenal follicular lymphoma . The combination of these 2 lymphomas in the same patient and the different clinical responses to antibiotic treatment make this case unique.

Cell Mol Biol Lett, 2004, 9(3), 483 - 95
Protective effect of vaccination with DNA of the H . Pylori genomic library in experimentally infected mice; Dzwonek A et al.; Immunologically mediated protection against H . pylori infection is an attractive alternative to antibiotic treatment . We compared the efficacy of conventional protein vaccination with that of genetic vaccination against experimental infection with H . pylori in mice . For oral immunization, we used the recombinant peptide of an antigenic fragment of UreB (rUreB) or H . pylori-whole cell lysate antigens, and for genetic immunization, we used recombinant pcDNA and pSec plasmids inserted with the fragment of ureB or DNA of the H . pylori genomic library . Mice were challenged with the mouse stomach-adapted H . pylori Sidney Strain . The detection of gastric bacterial colonization was performed by real-time PCR of a 26-kDa Helicobacter-specific gene, and the presence of serum H . pylori-specific antibodies was determined using direct ELISA assay . The most effective treatment appeared to be oral vaccination with rUreB and either intramuscular or intradermal vaccination with DNA of the H . pylori genomic library . Intradermal genetic vaccination with genomic library DNA significantly increased the IgG antibody response . Our study revealed acceptable efficacies of genetic vaccination with DNA of the H . pylori genomic library.

Ann Acad Med Singapore, 2004 Jul, 33(4), 532 - 6
Cutaneous Mycobacterium haemophilum infections in immunocompromised patients in a dermatology clinic in Singapore; Tan HH et al.; INTRODUCTION: Mycobacterium haemophilum, a nontuberculous mycobacterium (NTM) that was first described in 1978, is a pathogen that can cause an array of symptoms in immunocompromised patients, predominantly cutaneous . CLINICAL PICTURE: We report our hospital's experience with the first 3 patients diagnosed with this infection from 1994 to 2002 . All were women; one had systemic lupus erythematosus (SLE), one had mycosis fungoides and the last had Sjogren's syndrome with recurrent bacterial infections, although the specific nature of her immunocompromised state has not been defined . All were HIV negative . All 3 women presented with cutaneous lesions--the first with recurrent erythematous plaques on the limbs and back, the second with tender nodules and abscesses on the knees, and the third with papular eruptions on the cheek . TREATMENT/OUTCOME: All responded to a combination of antibiotics and are presently still undergoing treatment and follow-up . CONCLUSION: Infections caused by M . haemophilum occur mainly in immunocompromised patients . They can present with a variety of cutaneous manifestations, which require a high index of suspicion and coordination between the treating physician and the laboratory for diagnosis . Combination antibiotic treatment is recommended, and patients should be followed up after treatment to survey for possible relapse.

Infez Med, 2004 Mar, 12(1), 34 - 43
{The community acquired pneumonia: appropriateness of the admissions, risk factors and therapy}; Libanore M et al.; In a clinical and epidemiological study used Fine's Pneumonia Severity Index to determine the appropriateness of the hospitalisation of patients with community acquired pneumonia in the Internal Medicine Department of a hospital in Northern Italy . Risk factors and antibiotic treatment were checked against recent international guidelines . The study shows that 20% of the admissions were to be not appropriate . The principal risk factors were old age and such the co-morbidities heart failure, chronic cerebral diseases and COPD . In the home setting macrolides are less used than the new fluoroquinolones respirators . In the hospitals arrangements, b-lactams are still highly used, perhaps because of the high percentage of elderly patients . The data currently available suggest that some new fluoroquinolones such as levofloxacin are quite effective, presenting a broad spectrum of action, high bioavailability and good tolerability . Sequential therapy with this antibiotic leads to shorter hospitalisation times.

Br J Radiol, 2004 Aug, 77(920), 679 - 80
Thrombophlebitis diagnosed on indium-111 labelled white cell scan; English PJ et al.; A 64-year-old lady with type 2 diabetes and a non-resolving right foot ulcer, had an indium-111 labelled white cell scan (indium-111 WCS) to investigate the possibility of underlying osteitis . The scan suggested the possibility of infective thrombophlebitis . Unknown to the clinical team who requested the scan and the radiologist who performed it, the lady was admitted to hospital 2 days following the procedure with cellulitis and septic thrombophlebitis in the right leg . There is only one previous report in the literature of septic thrombophlebitis being diagnosed in this way . Perhaps indium-111 WCS has something to offer in the diagnosis of this condition and in determining those who require antibiotic treatment.

Gac Sanit, 2004 Jul-Aug, 18(4), 335 - 7
{The hospital faced with a prolonged Legionella outbreak}; Fernandez JA et al.; OBJECTIVE: To describe the health resources used in patients hospitalized with Legionella pneumonia during an outbreak of Legionnaire's disease in Alcoy (Spain), and to compare them with those used in other forms of pneumonia . METHODS AND RESULTS: Using a clinical protocol, 177 Legionella pneumonia patients were compared with 180 patients hospitalized for other types of pneumonia . Data on therapy and the resources used were collected . The most common antibiotic treatment in both groups was clarithromycin, but intensive care and mechanical ventilation requirements were greater in Legionella pneumonia . Home-based hospital care was successfully used in 15.6% of patients with Legionella pneumonia and in 11.3% of those with other types of pneumonia . Home oxygen therapy after discharge was less frequent in the Legionella pneumonia group (7.8%) than in the group with non-Legionella pneumonia (16.7%) . CONCLUSIONS: Notable results were the greater requirement for mechanical ventilation in Legionella pneumonia and the good results obtained by home-based hospital care within current health care management.

Scand J Immunol, 2004 Sep, 60(3), 273 - 7
The influence of remaining live BCG organisms in vaccinated mice on the maintenance of immunity to tuberculosis; Olsen AW et al.; The only available vaccine against Mycobacterium tuberculosis, the bacille Calmette-Guerin (BCG) vaccine, is at present being used as a reference for the efficacy of novel vaccines . Herein, we demonstrate that viable BCG can be detected at late time points after vaccination in C57BL/6J mice . If BCG is cleared by antibiotic treatment, the number of mycobacteria-reactive effector cells in the spleen gradually reverts to low levels and consequently immunity in this organ wanes, while resistance in the lung remains stable . The implications for comparing BCG vaccination with experimental vaccines including non-replicating vaccines are discussed.

QJM, 2004 Sep, 97(9), 591 - 7
High mortality of infant bacteraemia clinically indistinguishable from severe malaria; Evans JA et al.; BACKGROUND: Early recognition of children at highest risk of dying and the targeting of appropriate drug therapy are vital to the improvement of paediatric care in developing countries . This will rely upon the development of simple clinically-based algorithms and treatment guidelines . AIM: To determine the role of bacteraemia in children presenting with clinical signs and symptoms of severe malaria . DESIGN: Retrospective analysis of blood culture results following prospective data collection . METHODS: We studied 251 children presenting with symptoms and signs of severe malaria to a tertiary referral centre in Ghana . Blood was taken for malaria blood films, bacterial culture and haemograms . RESULTS: On the basis of clinical signs alone, malaria-film-positive (n = 182) and -negative (n = 69) patients were indistinguishable . Some 40% of film-negative patients were bacteraemic, vs . 12% of film-positive patients . Severe malaria and bacteraemia were not positively associated . Film-negative bacteraemic patients had a mortality of 39%, primarily affecting the age group <30 months . DISCUSSION: Infants presenting with symptoms and signs of severe malaria but a negative malaria film require immediate antibiotic treatment.

Allergy Asthma Proc, 2004 May-Jun, 25(3), 161 - 4
Incidence of resensitization after tolerating penicillin treatment in penicillin-allergic patients; Bittner A et al.; The incidence of resensitization to penicillin in patients with a history of penicillin allergy appears to be low but the approach to patients is controversial . We sought to determine the incidence of penicillin resensitization in patients with a history of penicillin allergy who had negative skin tests to penicillin determinants and received an initial uneventful course of beta-lactam antibiotics . We identified 254 patients who had negative penicillin skin testing to the major and minor penicillin determinants from January 1, 1994 to October 1999 and then reviewed their hospital and/or clinic records to determine if the patient had received subsequent treatment with beta-lactams or cephalosporins after the initial course of antibiotics . Of 254 patients, we were able to review 33/35 (94.3%) patients' charts to evaluate adverse reactions to the antibiotics . These 33 patients received a total of 77 subsequent courses of beta-lactam antibiotics and 19 subsequent courses of cephalosporins . Thirty of the 33 patients (90.9%) received at least one course of a parenterally administered cephalosporin or beta-lactam antibiotic . Seven of the 33 patients received only cephalosporin antibiotics . None of the identified patients had evidence of an immunoglobulin E-mediated reaction . Three of the 33 patients (9.1%) developed cutaneous skin eruptions during subsequent antibiotic treatment . Two of these three patients had subsequent uneventful treatment with beta-lactam antibiotics . The third patient who developed a nonblistering eruption underwent repeat penicillin skin testing, which remained negative . These data suggest that penicillin resensitization in previously allergic patients is very low and do not support the notion that penicillin skin testing should be performed before each subsequent course of beta-lactam antibiotics.

Chest, 2004 Aug, 126(2), 540 - 6
C-reactive protein and body mass index predict outcome in end-stage respiratory failure; Cano NJ et al.; STUDY OBJECTIVE: To determine the predictive factors of morbidity and mortality in patients with end-stage respiratory disease . DESIGN: Prospective, multicenter cohort study . SETTING: Thirteen outpatient chest clinics within the Association Nationale de Traitement a Domicile de l'Insuffisance Respiratoire . PARTICIPANTS: Stable adult patients with chronic respiratory failure receiving long-term oxygen therapy and/or home mechanical ventilation (n = 446; 182 women and 264 men; aged 68.5 +/- 12.1 years {+/- SD}); Respiratory diseases were COPD in 42.8%, restrictive disorders in 36.3%, mixed respiratory failure in 13.5%, and bronchiectasis in 7.4% . Recruitment was performed during the yearly examination . Patients with neuromuscular diseases and sleeping apnea were excluded . MEASUREMENTS AND RESULTS: Hospitalization days and survival were recorded during a follow-up of 14.3 +/- 5.6 months . Body mass index (BMI), serum albumin, and transthyretin levels were considered for their predictive value of outcome, together with demographic data, underlying respiratory disease, respiratory function, hemoglobin, C-reactive protein, smoking habits, oral corticosteroid use, and antibiotic treatment courses . Overall, 1.8 +/- 1.7 hospitalizations (cumulative stay, 17.6 +/- 27.1 days) were observed in 254 of 446 patients (57%) . Independent predictors of hospitalization were oral corticosteroids, FEV(1), and plasma C-reactive protein . One-year and 2-year cumulative survivals were 93% and 69%, respectively . Plasma C-reactive protein, BMI, Pao(2) on room air, and oral corticosteroids independently predicted survival in multivariate analysis . CONCLUSION: Besides established prognosis factors such as FEV(1) and Pao(2), nutritional depletion as assessed by BMI and overall systemic inflammation as estimated by C-reactive protein appear as major determinants of hospitalization and death risks whatever the end-stage respiratory disease . BMI and C-reactive protein should be included in the monitoring of chronic respiratory failure . Oral corticosteroids as maintenance treatment in patients with end-stage respiratory disease are an independent risk factor of death, and should be avoided in most cases.

Arch Intern Med, 2004 Aug 9-23, 164(15), 1669 - 74
Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis; Hepburn MJ et al.; BACKGROUND: Cellulitis is a condition routinely encountered in the primary care setting . No previous study has compared a short (5 days) vs standard (10 days) course of therapy of the same antibiotic in patients with uncomplicated cellulitis . METHODS: We performed a randomized, double-blind, placebo-controlled trial to determine if 5 days of therapy has equal efficacy to 10 days of therapy for patients with cellulitis . Of 121 enrolled subjects evaluated after 5 days of therapy for cellulitis, 43 were randomized to receive 5 more days of levofloxacin therapy (10 days total antibiotic treatment), and 44 subjects to receive 5 more days of placebo therapy (5 days of total antibiotic treatment) . Levofloxacin was given at a dose of 500 mg/d . Subjects were not randomized if they had worsening cellulitis, a persistent nidus of infection, a lack of any clinical improvement, or abscess formation within the first 5 days of therapy . The main outcome measure was resolution of cellulitis at 14 days, with absence of relapse by 28 days, after study enrollment . RESULTS: Eighty-seven subjects were randomized and analyzed by intention to treat . There was no significant difference in clinical outcome between the 2 courses of therapy (success in 42 {98%} of 43 subjects receiving 10 days of antibiotic, and 43 {98%} of 44 subjects receiving 5 days of antibiotic) at both 14 and 28 days of therapy . CONCLUSION: In patients with uncomplicated cellulitis, 5 days of therapy with levofloxacin appears to be as effective as 10 days of therapy.

Anim Reprod Sci, 2004 Sep, 84(3-4), 269 - 77
Effects of gentamicin sulfate on the contractility of myometrium isolated from non-pregnant cows; Ocal H et al.; Gentamicin sulfate, an aminoglycoside antibiotic known to cause depression of neuromuscular function, is a drug of choice in intrauterine antibiotic treatment of bovine chronical or subclinical uterine infections but its effects on the contractility of the cow uterus have not been studied . The aim of this study was to characterize, in vitro, the effect of gentamicin sulfate on spontaneous as well as prostaglandin F2alpha (PGF2alpha) and oxytocin-induced contractility of the non-pregnant cow uterus . Myometrial strips were isolated from non-pregnant cows in follicular phase and suspended in a jacketed organ bath filled with Krebs solution at 37 degrees C (pH 7.4) continuously bubbled with 95% oxygen and 5% carbon dioxide and isometric contractions were recorded using isometric force displacement transducer . After manifestation of the spontaneous contractions during equilibration period the test substances PGF2alpha (1 microM), oxytocin (2.5 mIU/ml bath fluid) and gentamicin sulfate (150-600 microm) were added to the bath . The effects of gentamicin sulfate on amplitude (g) and frequency of spontaneous and the agonist-induced contractions were evaluated by 20 min intervals . Data were statistically analyzed using the Student's t-test and Wilcoxon signed-rank test where appropriate . P <0.05 was considered to be significant . Gentamicin sulfate inhibited spontaneous, as well as oxytocin or PGF2alpha-induced contractions in a dose-dependent manner . Although both the frequency and amplitude of contractions were significantly inhibited by gentamicin sulfate, the effect on the frequency of the spontaneous and agonist-induced contractions were more prominent than on the amplitude . The result from this in vitro study indicated that gentamicin sulfate inhibits spontaneous as well as oxytocin and PGF2alpha-induced contractions of myometrium isolated from non-pregnant cows . This may be of importance considering the potentially negative effect of gentamicin sulfate on uterine involution in cows with puerperal endometritis, resulting in impairment of fertility performance.

Eur J Cardiothorac Surg, 2004 Sep, 26(3), 503 - 7
Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase; Ekingen G et al.; OBJECTIVE: Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions . In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest tube drainage . Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions . Our study reviews the results of streptokinase treatment in children with pleural effusion . METHODS: Thirty-two patients with parapneumonic pleural effusions were admitted to our hospital . The patients beyond the exudative stage were divided into two groups according to the initial radiological findings and biochemical parameters of pleural fluid . Intrapleural streptokinase treatment was started in an average of 2 days following initial chest tube placement in both Group I (14 patients) in fibrino-purulent phase with pleural effusion and fluid volume estimated to be larger than one-third of the involved lung and Group II (18 patients) with additional findings in radiological examination regarding the presence of air-fluid levels, multiple loculations, necrotic debris and pleural thickening . The effectiveness of therapy was assessed by monitoring the volume of the fluid, the level of LDH, glucose, pH and by radiological imaging, pre- and post-instillation . RESULTS: There was statistically significant difference between two groups according to date of admission (6.8 vs 10.4 days), mean of total pleural fluid drainage before (106.9 vs 309.7 ml) and after (258.9 vs 511.2 ml) SK treatment, mean of total number of instillations (2.1 vs 3.6) required and total length of hospital stay (16.6 vs 22.4 days) . There was a significant difference regarding pleural chemical analysis . Finally, surgical intervention was necessary in six intractable cases, all of which initially presented a significant small amount of pleural drainage in volume when compared to rest of the patients . The overall success rate of our treatment was calculated as 96% for G-I and 72.2% for G-II cases . CONCLUSIONS: Intrapleural streptokinase is an effective and safe adjunct in facilitating drainage in early and late stage II empyemas . A tendency of decreased rate of drainage besides persisting fever and respiratory symptoms, despite fibrinolytic treatment may be a clue for early surgical intervention.

Z Arztl Fortbild Qualitatssich, 2004 Jun, 98(4), 259 - 63
{Acute otitis media and its life-threatening complications}; Preyer S; Acute otitis media is a widespread disease affecting all ages . The introduction of antibiotics has led to a reduction in the incidence of complications from approx . 17% to 1% . Nevertheless, life-threatening complications still occur . The present paper describes the course and treatment of mastoiditis, petrositis and sepsis, as well as intracranial complications, i.e . meningitis, sigmoid sinus thrombosis, extradural abscess, subdural empyema, brain abscess and otitic hydrocephalus . The importance of antibiotic treatment for acute otitis media and the need to assess treatment outcomes are emphasised.

Infection, 2004 Aug, 32(4), 210 - 6
Outcomes of ventilated COPD patients with nosocomial tracheobronchitis: a case-control study; Nseir S et al.; BACKGROUND: The aim of this study was to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD) . PATIENTS AND METHODS: A prospective observational case-control study was conducted in medical COPD patients requiring intubation and mechanical ventilation for more than 48 hours . Patients with nosocomial pneumonia were excluded . Six matching criteria were used, including the duration of mechanical ventilation before NTB occurrence . RESULTS: 81 matched case-control pairs were studied . Although the mortality rate was similar (40% vs 34%; p = 0.48), median duration of mechanical ventilation (20 vs 12 days; p = 0.015) and intensive care unit (ICU) stay (25 vs 18 days; p = 0.022) were higher in cases than in controls . NTB was independently associated with a longer than median period of mechanical ventilation among case and control patients (OR = 4.7 {95%CI = 2-10.9}; p < 0.001) . In cases with appropriate antibiotic treatment compared with those who did not receive antibiotics, a shorter median duration of mechanical ventilation (12 vs 23 days; p = 0.006) and ICU stay (16 vs 29 days; p = 0.029) were observed . CONCLUSION: NTB is associated with an increased duration of mechanical ventilation and ICU stays . Further studies are required to determine whether antibiotics could improve the outcome of patients with NTB.

Rev Mal Respir, 2004 Jun, 21(3 Pt 1), 591 - 4
{Actinomycosis presenting as a chronic excavated pneumonia in a young woman}; Lacassagne L et al.; INTRODUCTION: Pulmonary actinomycosis is an anaerobic bacterial infection occurring primarily in debilated patients with poor oral hygiene . Before the penicillin era, thoracic actinomycosis looked like tuberculosis or neoplasia with chest wall invasion and fistula formation . OBSERVATION: We report the case of a 39 years old woman presenting with a chronic lung abscess of the left upper lobe hospitalised after several unsuccessful courses of antibiotics . The diagnosis was made after thoracic surgery . Three years after lobectomy, which had been followed by three months of amoxycillin and multiple dental extractions, there was no sign of relapse of the infection . CONCLUSIONS: We review the role of thoracic surgery, antibiotic treatment and diagnosis in pulmonary actinomycosis.

J Clin Psychiatry, 2004 Jul, 65(7), 919 - 21
Neurosyphilis in newly admitted psychiatric patients: three case reports; Saik S et al.; BACKGROUND: Neurosyphilis, also known as "general paresis of the insane," at one time accounted for a large portion of admissions to state psychiatric facilities . With the introduction of antibiotics, neurosyphilis is now considered very rare . METHOD: Chart review was performed on patients diagnosed with neurosyphilis who were admitted to a state psychiatric hospital in Raleigh, N.C., during 2002 . RESULTS: We identified 3 cases of confirmed neurosyphilis, representing 0.1% of adult admissions, diagnosed in newly admitted psychiatric patients . None of the patients were immunocompromised . Response to antibiotic treatment was poor . CONCLUSIONS: Given the increase in primary and secondary syphilis reported in the 1980s and early 1990s, routine screening of psychiatric patients for the presence of syphilis should be considered.

JPEN J Parenter Enteral Nutr, 2004 Jul-Aug, 28(4), 269 - 71
Long-term parenteral nutrition, via the azygos system, in an adolescent with cystic fibrosis; El Dannawi S et al.; Venous access device is critically needed for long-term parenteral nutrition (PN), especially in children with chronic disease such as cystic fibrosis, short bowel syndrome, and permanent intestinal failure . When traditional sites are unavailable and venous access is very limited, alternative central routes are required . The access to the azygos system has been shown to be a safe, relatively easy solution in those special situations . We report the case of an adolescent who benefited from this central venous access for long-term PN and antibiotic treatment for >7 years with a limited number of complications.

Eur J Pediatr . 2004 Jul 28; {Epub ahead of print}
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.

Joint Bone Spine, 2004 Jul, 71(4), 352 - 4
Acute pseudoseptic arthritis after intraarticular sodium hyaluronan; Roos J et al.; A 70-year-old woman with a history of knee osteoarthritis was admitted for acute arthritis 9 days after a second intraarticular injection of sodium hyaluronan (Ostenil) . The joint fluid was purulent, with no crystals, and laboratory tests showed marked inflammation, leading to antibiotic treatment for suspected septic arthritis . Incapacitating symptoms persisted, prompting surgical lavage of the knee, which failed to relieve the severe pain . The persistent symptoms and negative results of joint fluid and blood cultures led to discontinuation of the antibiotic therapy after 10 days . Antiinflammatory therapy relieved the symptoms, and the patient was discharged home 1 month after her admission . Nevertheless, the pain persisted, requiring rehabilitation therapy of the knee . Aseptic arthritis induced by repeated sodium hyaluronan injection is the most likely diagnosis . Physicians should be aware of this extremely severe complication.

Klin Padiatr, 2004 Jul-Aug, 216(4), 236 - 7
{Multilocular erythema migrans in borreliosis}; Krischer S et al.; BACKGROUND: Borreliosis is the most common vector transmitted disease in childhood . Although the disease manifests with an erythema migrans in 80 % of the patients, multilocular skin manifestations are only observed in 2-18 % of these . Differential diagnoses of erythema migrans include erysipelas, persistent insect bite reaction, and fixed drug eruption, in particular when the clinical history does not reveal a tick bite . PATIENT: We report on a 5-year-old boy showing nine erythemas with central pallor on his face, trunk, arms and legs . He recalled a tick bite 3 weeks before . RESULTS: Serological studies revealed an acute infection with Borrelia burgdorferi . After antibiotic treatment with orally administered amoxicillin skin manifestations resolved within three days . During a follow-up period of six months the patient revealed no signs of persistent borreliosis . CONCLUSION: Multilocular erythema migrans is a possible manifestation of borreliosis and is classified as disseminated early infection which is frequently associated with systemic reactions, including malaise, arthritis, carditis, headache and even meningeal signs . Treatment is based on antibiotics, which should preferably be given intravenously in case of systemic signs.

Laryngoscope, 2004 Aug, 114(8), 1435 - 7
Nontuberculous mycobacteria-induced parotid lymphadenitis successfully limited with clarithromycin and rifabutin; Shah MB et al.; OBJECTIVES/HYPOTHESIS: Nontuberculous mycobacterial adenitis of the parotid gland is often difficult to diagnose . The rarity of these infections in the parotid region and the lack of specific guidelines pose a treatment challenge to the clinician . Three cases of nontuberculous mycobacterial adenitis are presented, with clinical response to antibiotics before surgery . STUDY DESIGN: Retrospective chart review was made of children up to 18 years of age presenting with a parotid mass diagnosed as nontuberculous mycobacterial infection . METHODS: Three patients (age range, 15 to 30 mo) with nontuberculous mycobacteria-induced parotid lymphadenitis were treated with a combination antibiotic regimen of clarithromycin and rifabutin or with clarithromycin alone . RESULTS: All three patients responded clinically to the antibiotic treatment as evidenced by a smaller mass size and resolution of the overlying discoloration . Subsequent parotidectomy or biopsy appeared to be easier to perform because of decreased inflammation and edema and a more readily dissectible facial nerve . CONCLUSION: Children with nontuberculous mycobacteria-induced parotid lymphadenitis should be started on a trial of antibiotic treatment before surgery . Although surgery remains the definitive treatment modality, a larger study of preoperative antibiotic use against nontuberculous mycobacterial adenitis of the parotid in children is necessary.

Clin Exp Immunol, 2004 Aug, 137(2), 288 - 97
Mycoplasma infection induces a scleroderma-like centrosome autoantibody response in mice; Gavanescu I et al.; Development of autoantibodies to intracellular molecules is a universal feature of autoimmune diseases and parallels onset of chronic inflammatory pathology . Initiating antigens of disease-specific autoantibody responses are unknown . We previously showed that the major targets of autoantibodies in scleroderma are centrosomes, organelles involved in mitotic spindle organization . Here we show that centrosome autoantibodies are induced in mice by mycoplasma infection . The centrosome-specific antibody response involves class switching of preexisting IgM to IgG isotypes, suggesting a T cell-dependent mechanism . The antibody response spreads to include additional intracellular targets, with newly recruited autoantibody specificities arising as IgM isotypes . Antibiotic treatment of mice prevents autoantibody development . Centrosome autoantibodies may provide an aetiological link between infection and human autoimmunity and suggest novel therapeutic strategies in these disorders.

Cochrane Database Syst Rev . 2004;(3):CD004697.
Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical artery catheters; Inglis GD et al.; BACKGROUND: Umbilical artery catheters are often used in unwell neonates . Infection related to the use of these catheters may cause significant morbidity and mortality . The use of prophylactic antibiotics has been advocated for all newborns with umbilical artery catheters in order to reduce the risk of colonisation and acquired infection . Countering this is the possibility that harm may outweigh benefit . OBJECTIVES: The primary objective was to assess whether prophylactic antibiotics, in neonates with umbilical artery catheters, reduce mortality and morbidity . In separate comparisons, we planned to review two different policies regarding the prophylactic use of antibiotics in neonates with umbilical artery catheters: 1) among neonates with umbilical artery catheters, a policy of prophylactic antibiotics for the duration of catheterisation (or other fixed duration of antibiotic treatment) versus placebo or no treatment; 2) among neonates with umbilical artery catheters who had been started on antibiotics at the time of catheterisation but whose initial cultures to rule out sepsis are negative, a policy of continuing versus discontinuing prophylactic antibiotics . SEARCH STRATEGY: We searched MEDLINE (January 1966 to February 2004), CINAHL (1982 to February 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004), the Cochrane Neonatal Group Specialised Register and reference lists of articles . SELECTION CRITERIA: Randomised controlled trials of adequate quality in which newborn infants with umbilical artery catheters are randomised to receive prophylactic antibiotics versus placebo or no treatment . DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality . MAIN RESULTS: No study met the criteria for inclusion in this review . REVIEWERS' CONCLUSIONS: There is no evidence from randomised trials to support or refute the use of prophylactic antibiotics when umbilical artery catheters are inserted in newborn infants, or to support or refute continuing antibiotics once initial cultures rule out infection in newborn infants with umbilical artery catheters.

Acta Paediatr Taiwan, 2004 Jan-Feb, 45(1), 35 - 7
Extravasation of calcium gluconate concomitant with osteomyelitis in a neonate; Chiang MC et al.; Extravasation of calcium gluconate is not an uncommon complication in neonatal units, which may result in skin and soft tissue inflammation, injury and even infection . We report an 11-day-old preterm infant who developed osteomyelitis at an infiltrated intravenous site through which calcium gluconate was infused . The patient was initially treated conservatively as a simple calcium-infiltrate . Clinical condition deteriorated until proper antibiotic treatment was given . We exclude other possible causes and assume that calcium-infiltrate had an important role in the pathogenesis . We conclude that osteomyelitis should be considered in a patient with calcium extravasation whose soft tissue inflammation does not improve as expected . Furthermore, using a diluted calcium solution and checking the insertion site frequently in order to identify extravasation earlier would prevent the complication.

Minerva Stomatol, 2004 May, 53(5), 263 - 71
An objective method of assessing facial swelling in patients with dental abscesses treated with clarithromycin; Montebugnoli L et al.; AIM: The study evaluates the efficacy of a set of objective parameters for monitoring facial swelling in a group of patients treated with clarithromycin . METHODS: Fifty consecutive patients suffering from dental abscesses (22 in the maxillary arch and 28 in the mandibular arch) were enrolled . All these patients underwent antibiotic treatment with clarithromycin in a new formulation as a single daily dose (500 mg/day for 6 days) . Pain and changes in facial swelling were evaluated at baseline and each day for 6 days through subjective parameters (visual analogic scale, VAS) and objective parameters (6 different tape measurements on the skin surface above the abscess) . RESULTS: Pain and swelling recorded by patient and dentist (using VAS scores) showed statistically significant decreases (p<0.01) on days 2, 3 and 4, while no further significant variation was observed during days 4, 5 or 6 . As regards the objective parameters to quantify facial swelling, the maximum dimensional change (from baseline to final values) in the mandibular arch was obtained with measurement 6 (mean value 2.27+/-0.53 cm); the maximum dimensional change in the maxillary arch was obtained with the sum of the other 5 measurements (mean value 6.34+/-4.09 cm) . CONCLUSION: The use of a single or a combination of linear measurements might provide a sensitive and reproducible method to evaluate facial swelling objectively and could be very useful in monitoring the efficacy of new antibiotics and to compare the results from different studies.

J Assoc Physicians India, 2003 Nov, 51, 1055 - 60
Early human safety study of turmeric oil (Curcuma longa oil) administered orally in healthy volunteers; Joshi J et al.; OBJECTIVE: Turmeric extract and turmeric oil have shown chemoprotective effect against chemically-induced malignancies in experimental animals . They can reverse precancerous changes in oral submucous fibrosis in humans . The use of turmeric or Curcuma longa Linn as a spice and household remedy has been known to be safe for centuries . In view of the long term administration required for cancer prevention a Phase I clinical trial of turmeric oil (TO) was designed to study the safety and tolerance of TO in volunteers for a period of 3 months . MATERIAL AND METHODS: Nine healthy volunteers between 20 and 33 years of age were tested for haemoglobin, blood counts, liver and kidney functions, bleeding and clotting time and serum electrolytes initially and at 1 and 3 months of treatment . They were administered 0.6 ml of TO three times a day for 1 month and 1 ml in 3 divided doses for 2 months . The acute tolerability study on Day 1 was conducted in a Clinical Pharmacology daycare Unit . Blood pressure and pulse were recorded frequently on Day 1 and at 24, 48, 72 and 96 hours and fortnightly till 12 weeks . Volunteers were daily supervised for TO intake as well as for any side effects throughout the study period . RESULTS: Nine volunteers were enrolled for the study . One discontinued on 3rd day for allergic skin rashes which, on discontinuation of TO, gradually disappeared by two weeks . Another discontinued on 7th day for intercurrent fever requiring antibiotic treatment . Seven volunteers completed the study . There was no effect of TO, in two doses, on pulse and blood pressure and no side effects in acute tolerability study on Day 1 . There was no effect of TO intake on weight, blood pressure, symptoms and signs upto 12 weeks . There was no clinical, haematological, renal or hepatic-toxicity of TO at 1 month and 3 months . Serum lipids did not show significant change except in one volunteer (reversible) . CONCLUSIONS: In view of the potential for reversing oral submucous fibrosis, a precancerous condition for oral cancer, TO, can be recommended directly for a Phase II trial in patients.

An Otorrinolaringol Ibero Am, 2004, 31(3), 215 - 22
{Review of acute otomastoiditis in the paediatric population . Our cases}; Pino Rivero V et al.; The introduction of antibiotics has decreased the number of acute mastoiditis as complication of otitis media in children . However, this pathology still is a serious infection . Its incidence has increased in the last years and goes on getting diagnostic and therapeutic problems . We are reporting an own review about 18 children diagnosed as acute otomastoiditis, hospitalized in a 10 years period, with ages between 10 months and 14 years . We have analysed different parameters standing out the otoscopic and radiologic findings, clinical symptoms, previous antibiotic treatment, type of surgical intervention performed and complications.

Nervenarzt, 2004 Jun, 75(6), 553 - 7
{Clinical courses of acute and chronic neuroborreliosis following treatment with ceftriaxone}; Kaiser R; Between 1990 and 2000, a total of 101 patients with acute (n=86) or chronic (n=15) neuroborreliosis (proven by clinical data, pleocytosis in the CSF, and elevated Borrelia burgdorferi-specific antibody indices) were treated with 2 g of ceftriaxone per day for either 2 or 3 weeks . The patients were reexamined clinically and serologically after 3, 6, and 12 months . Six (12) months after the antibiotic treatment, about 93% (95%) of the patients with acute neuroborreliosis and 20% (66%) of the patients with chronic neuroborreliosis were cured . One year after treatment, four patients with acute neuroborreliosis still suffered from facial palsy and five with chronic neuroborreliosis still had moderate spastic ataxic gait disturbance . The prognosis of facial palsy in neuroborreliosis is quite similar to that in idiopathic facial palsy, while that in chronic neuroborreliosis largely depends on the time elapsed before diagnosis.

Minerva Chir, 2004 Jun, 59(3), 301 - 5
Laparoscopic treatment of post-hysterectomy colovaginal fistula in diverticular disease . Case report; Finco C et al.; Colonic diverticular disease is a benign condition typical of the Western world, but it is not rare for even the 1st episode of diverticulitis to carry potentially fatal complications . The evolution of a peridiverticular process generally poses problems for medical treatment and exposes patients to repeated episodes of diverticulitis, making surgical treatment necessary in approximately 30% of symptomatic patients . One of the most worrying complications of diverticulosis is internal fistula . The most common types of fistula are colovesical and colovaginal, against which the uterus can act as an important protective factor . The symptoms and the clinical and instrumental management of patients with diverticular fistulas are much the same as for patients with episodes of acute diverticulitis . Staging of the disease (according to Hinchey) should be done promptly so that the necessary action can be taken prior to surgery, implementing total parenteral nutrition (TPN), nasogastric aspiration and broad-spectrum antibiotic treatment . The best surgical approach to adopt in patients with diverticulitis complicated by fistula is still not entirely clear, though the 3-step strategy is currently tending to be abandoned due to its high morbidity and mortality rates . There is a widespread conviction, however, that the 2-step strategy (Hartmann, or resection with protective stomy) and the 1-step alternative should be reserved, respectively, for patients in Hinchey stages 3, 4 and 1, 2 with a situation of attenuated local inflammation . The 1-step approach seems to be safe and effective . This report describes a case of colovaginal fistula in a patient with colonic diverticulosis who had recently undergone hysterectomy, but who, unlike such cases in the past, was treated in a single step using a laparoscopic technique.

Curr Gastroenterol Rep, 2004 Aug, 6(4), 280 - 6
Infectious complications of pancreatitis: diagnosis and management; Mishra G et al.; Infected pancreatic necrosis is the leading cause of death in patients with severe acute pancreatitis . Early prophylactic antibiotic treatment is effective in preventing conversion of sterile necrosis to pancreatic infection, but its effect on mortality remains unproven . Fungal infections may predict a worse outcome, but no evidence supports the use of antifungal prophylaxis . Because infection of pancreatic necrosis by enteric bacteria can develop despite prophylaxis, a high index of suspicion should allow early detection followed by aggressive management.

Basic Clin Pharmacol Toxicol, 2004 Jul, 95(1), 20 - 3
Influence of spironolactone treatment on gentamicin-induced nephrotoxicity in rats; Ali BH et al.; The effect of treatment of rats with gentamicin (80 mg/kg/day for 6 days), oral doses of spironolacatone (20 mg/kg/day for 6 days), and the combined treatment (spironolactone + gentamicin) on renal histology and reduced glutathione (GSH) concentration, and some serum constituents indicative of kidney function were studied . The serum concentrations of creatinine and urea were not significantly affected by spironolactone treatment, but were significantly elevated (P<0.05) by gentamicin administration . The antibiotic treatment also reduced GSH concentration and caused a moderate renal cortical necrosis . However, rats exposed to spironolactone + gentamicin revealed drastic increases in the serum urea and creatinine concentrations amounting to about 1.8 and 2.1 times those of rats treated with gentamicin alone, respectively . The histological examination of slides of the renal cortex of rats exposed to the combined drugs exhibited more extensive necrosis in the tubules when compared to those treated with gentamicin alone . The reduction in GSH induced by gentamicin was unaffected by the concomitant treatment of gentamicin and spironolactone . The concentration of gentamicin accumulated in the renal cortex was significantly larger (twofold) in rats treated concomitantly with spironolactone + gentamicin than in rats treated with gentamicin alone . The present results indicate that spironolactone aggravates gentamicin-induced nephrotoxicity in the rat.

Eur J Clin Microbiol Infect Dis, 2004 Aug, 23(8), 615 - 8 Epub 2004 Jul 08.
Pre-treatment and post-treatment assessment of the C(6) test in patients with persistent symptoms and a history of Lyme borreliosis; Fleming RV et al.; It was recently reported that antibody to C(6), a peptide that reproduces an invariable region of the VlsE lipoprotein of Borrelia burgdorferi, declined in titer by a factor of four or more in a significant proportion of patients after successful antibiotic treatment of acute localized or disseminated Lyme borreliosis . The present study evaluated the C(6) test as a predictor of therapy outcome in a population of patients with post-treatment Lyme disease syndrome . The serum specimens tested were from patients with well-documented, previously treated Lyme borreliosis who had persistent musculoskeletal or neurocognitive symptoms . All of the patients had participated in a recent double-blind, placebo-controlled antibiotic trial in which serum samples were collected at baseline and 6 months thereafter, i.show $132#e . 3 months following treatment termination . In this patient population no correlation was found between a decline of C(6) antibody titer of any magnitude and treatment or clinical outcome . Antibodies to C(6) persisted in these patients with post-treatment Lyme disease syndrome following treatment, albeit at a markedly lower prevalence and titer than in untreated patients with acute disseminated Lyme disease . The results indicate that C(6) antibody cannot be used to assess treatment outcome or the presence of active infection in this population.

Hepatogastroenterology, 2004 Jul-Aug, 51(58), 1172 - 4
Quality of life following acute necrotizing pancreatitis; Szentkereszty Z et al.; BACKGROUND/AIMS: The authors examine the quality of life of patients treated for acute necrotizing pancreatitis an average of 37.8 months following their illness . METHODOLOGY: The questionnaire used in the examinations was a version of the Short Form-36 (SF-36) which was adapted to a Hungarian environment and included additional questions regarding the patient's illness . During the treatment of the pancreatic necrosis, prophylactic antibiotic treatment, early nasojejunal feeding, percutaneous peripancreatic drainage, and late surgical necrectomy was used . Postoperatively the lavage of the closed omental bursa was performed . RESULTS: It was determined that 77.3% of patients considered their quality of life to be good or fair . Quality of life was considered worse in older patients, patients with complaints of abdominal distension and bowel problems, patients who had lost significant amounts of weight since their illness, patients with poor appetite, and patients who were female . CONCLUSIONS: The long-term result, and the quality of life after acute necrotizing pancreatitis is good.

Eur Arch Otorhinolaryngol . 2004 Jul 2; {Epub ahead of print}
Parapharyngeal abscess: diagnosis, complications and management in adults; Alaani A et al.; Parapharyngeal abscess may cause life-threatening complications . Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess . Since the introduction of antibiotics, the incidence of parapharyngeal abscess secondary to tonsillitis and peritonsillar abscess has decreased dramatically . We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar infection extending to the parapharyngeal space in adult patients . Two were complicated by mediastinitis despite early treatment by wide spectrum antibiotics . We believe that early diagnosis and aggressive antibiotic treatment with early surgical drainage in cases associated with pus collection are the key points in preventing serious and fatal complications . We emphasize the diagnostic role of computerized tomography (CT) scan and the importance of early and proper drainage of these abscesses.

Pediatrics, 2004 Jul, 114(1), 9 - 12
Juvenile recurrent parotitis: a new method of diagnosis and treatment; Nahlieli O et al.; OBJECTIVE: Juvenile recurrent parotitis (JRP) is a nonobstructive, nonsuppurative parotid inflammation in young children . Causative factors, such as local autoimmune manifestation, allergy, infection, and genetic inheritance, have been suggested, but none of them has been proved to date . Until now, treatment of JRP was divided into conservative observation and antibiotic treatment, and no preventive therapy was available . METHODS: Twenty-six cases symptomatic JRP in children were diagnosed and treated with a combined endoscopic approach . Sialography and sialoendoscopy were performed bilaterally in all children . The treatment modality was composed of lavage, ductal dilation, and hydrocortisone injection . RESULTS: Sialography showed multiple sialectasis in the affected gland and in the contralateral one as well . Dilations and strictures were noticed in the main duct, and kinks could be identified in 31% of the glands . The main endoscopic finding was a white appearance of the ductal layer without the healthy blood vessel coverage . Recurrence of the symptoms occurred in only 2 (8%) children . CONCLUSIONS: The endoscopic technique provides the possibility of a correct diagnosis and treatment . In this article, we present a new treatment modality of irrigation and dilation under direct vision by endoscopically guided miniature surgical instruments.

Pediatrics, 2004 Jul, 114(1), 1 - 8
Measurement of interleukin 8 in combination with C-reactive protein reduced unnecessary antibiotic therapy in newborn infants: a multicenter, randomized, controlled trial; Franz AR et al.; OBJECTIVE: Neonatal bacterial infections carry a high mortality when diagnosed late . Early diagnosis is difficult because initial clinical signs are nonspecific . Consequently, physicians frequently prescribe antibiotic treatment to newborn infants for fear of missing a life-threatening infection . This study was designed to test the hypotheses that a diagnostic algorithm that includes measurements of interleukin 8 (IL-8) and C-reactive protein (CRP) 1) reduces antibiotic therapy and 2) does not result in more initially missed infections compared with standard management that does not include an IL-8 measurement . METHODS: Term and preterm infants who were <72 hours of age and had clinical signs or obstetric risk factors suggesting neonatal bacterial infection but stable enough to wait for results of diagnostic tests were enrolled into the study . A total of 1291 infants were randomly assigned to receive antibiotic therapy according to the guidelines of each center (standard group) or to receive antibiotic therapy when IL-8 was >70 pg/mL and/or CRP was >10 mg/L (IL-8 group) . The primary outcome variables were 1) the number of infants treated with antibiotics and 2) the number of infants with infections missed at the initial evaluation . RESULTS: In the IL-8 group, fewer infants received antibiotic therapy than in the standard group (36.1% {237 of 656} vs 49.6% {315 of 635}) . In the IL-8 group, 24 (14.5%) of 165 infants with infection were not detected at the initial evaluation, compared with 28 (17.3%) of 162 in the standard group . CONCLUSIONS: The number of newborn infants who received postnatal antibiotic therapy can be reduced with a diagnostic algorithm that includes measurements of IL-8 and CRP . This diagnostic strategy seemed to be safe.

Rhinology, 2004 Jun, 42(2), 57 - 62
Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients; Lund VJ et al.; This study evaluated the efficacy and tolerability of budesonide in an aqueous nasal spray (BANS) in patients with chronic rhinosinusitis . In this double-blind, placebo-controlled, multicentre, parallel-group study, patients (n = 167) with persistent rhinosinusitis symptoms despite 2-weeks' antibiotic treatment were randomised to receive BANS 128 micrograms b.i.d . or placebo for 20 weeks . Morning combined symptom scores (CSS) in patients receiving BANS decreased by a mean of -1.85 (95% CI -2.27, -1.43), versus -1.02 (-1.43, -0.61) in the placebo group (p = 0.005); corresponding values for evening CSS were -1.78 (-2.22, -1.35) and -1.02 (-1.45, -0.60), respectively (p = 0.012) . BANS produced significant reductions in nasal congestion and discharge scores, and improved patients' sense of smell (morning only), versus placebo . Peak nasal inspiratory flow (PNIF) increased significantly during BANS treatment . In allergic patients, BANS significantly (p < 0.001) reduced both morning -1.40 (-2.18, -0.62) and evening -1.37 (-2.15, -0.58) CSS from baseline versus placebo, but changes in non-allergic patients (morning: -0.04 {-0.95, 0.87}; evening: 0.14 {-0.81, 1.09}) were not significant . PNIF was significantly (p < 0.01) increased in both allergic and non-allergic patients from baseline versus placebo . BANS is an effective and well-tolerated treatment for chronic rhinosinusitis.

Ann Pathol, 2004 Apr, 24(2), 192 - 7
{Histological features of cutaneous secondary syphilitic lesions: a report of two cases}; Vasiliu V et al.; Syphilis is a sexually transmitted infectious disease, which currently shows a high increase of incidence in HIV negative patients . These patients often seek medical advice at a stage of secondary syphilis, as the lesions of the primary phase may pass unperceived . Very often, the diagnosis is evoked through a cutaneous biopsy, since the clinical presentation is often misleading . Even though the histological signs are not specific, they may suggest the diagnosis, by showing a psoriasiform epidermal hyperplasia with neutrophil exocytosis and a dermal lichenoid infiltrate rich in plasma cells . However, it is important to underline the great polymorphism of these lesions, which can easily vary according to the stage and /or clinical form . It's very important to have a quick and accurate diagnosis, because the lesions are very contagious, but rapidly and completely cured by an early administrated antibiotic treatment.

J Vasc Surg, 2004 Jul, 40(1), 164 - 6
Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair; Koeppel TA et al.; Mycotic aortic aneurysms are rare . Improved diagnostic procedures, appropriate antibiotic treatment, and safe surgical techniques have reduced the high mortality associated with bacterial aortitis . However, definite evidence-based conclusions with regard to the surgical strategy cannot be drawn from the data available in the published literature . We report successful endovascular repair of a mycotic abdominal aortic aneurysm . Endovascular treatment may offer a benefit, especially in critically ill patients.

J Pediatr Surg . 2004 Jul;39(7):1150.
Diagnostic aspects of cervical lymphadenopathy in children in the developing world: A study of 1877 surgical specimens: S.W . Moore, J.W . Schneider, and H.S . Schaaf . Pediatr Surg Int 19:240-244, (June), 2003; Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial; Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi 983-0824, Japan . keiito@openhp.or.jp

OBJECTIVE: This study was performed to determine and compare the effectiveness and incidence of complications of percutaneous cholecystostomy and gallbladder aspiration in cases of severe acute cholecystitis . SUBJECTS AND METHODS . Fifty-eight patients with severe acute cholecystitis who did not improve after antibiotic treatment were included in this study . The patients were randomized into either the percutaneous cholecystostomy group (n = 30) or the gallbladder aspiration group (n = 28) . Under sonographic guidance, percutaneous cholecystostomy was performed in the usual manner using a 6.5- or 7-French catheter . Gallbladder aspiration was carried out with a 21-gauge needle under sonographic guidance . The technical success, clinical response, and complications in each group were evaluated . RESULTS: Percutaneous cholecystostomy and gallbladder aspiration were technically successful in 30 patients (100%) and 23 patients (82%), respectively (not statistically significant) . In five patients (18%) of the gallbladder aspiration group, aspiration was unsuccessful because of replacement of bile with dense biliary sludge or pus . Good clinical response was obtained in 27 patients (90%) of the percutaneous cholecystostomy group and in 14 patients (61%) of the gallbladder aspiration group (p < 0.05) . As for complications, dislodgment of the catheter occurred in one patient of the percutaneous cholecystostomy group and minor bleeding in one patient after gallbladder aspiration . No major complications or procedure-related deaths occurred in either group . CONCLUSION: For severe acute cholecystitis, percutaneous cholecystostomy was superior to gallbladder aspiration in terms of clinical effectiveness and had the same complication rate as gallbladder aspiration.

Dermatol Clin, 2004 Jul, 22(3), 313 - 20, vi-vii
Tularemia: the disease and the weapon; Cronquist SD; Tularemia is a bacterial infection usually transmitted via arthropod vectors or direct contact with infected animals . Naturally occurring cases are relatively rare, and can result in six different clinical syndromes . Tularemia is also a potential agent of bioterrorism or biowarfare, and is categorized as a high-level threat . Effective antibiotic treatment is available, including potential use of oral antibiotics in a mass casualty situation . An awareness of potential clinical presentations of tularemia will facilitate timely intervention,appropriate diagnostic testing, and decreased morbidity in the event of a biologic attack with Francisella tularensis.

J Small Anim Pract, 2004 Jun, 45(6), 304 - 6
Gastrocutaneous fistula as a result of migration of a foreign body in a dog; Brennan SF et al.; A six-year-old, female Tibetan terrier was referred for investigation of a non-healing wound on the left caudal thorax . A subcutaneous swelling had initially developed on the chest wall, followed by a draining tract from which seropurulent fluid drained for two months . There had been no response to antibiotic treatment . Following radiographic and ultrasonographic examinations, a bone sequestrum from a fractured rib or a foreign body was suspected . Surgical exploration of the wound identified a sinus tract and a wooden foreign body (an ice-lolly stick) was located in subcutaneous tissues . Partial wound dehiscence of the surgical site occurred postoperatively, but healed after 10 days . One month later, fluid began to discharge from the area again . Further surgical exploration confirmed a gastrocutaneous fistula . Dissection of the fistula and surgical closure of the stomach, body wall and skin led to resolution of all signs.

Hernia, 2004 Aug, 8(3), 190 - 2 Epub 2004 Jun 16.
Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible?
Campanelli G, Nicolosi FM, Pettinari D, Avesani EC.
INTRODUCTION: Prosthetic repair for abdominal wall hernia currently represents the gold standard . However, it is still difficult to identify the correct indication for prosthetic implant in borderline cases . The authors propose evaluating whether a prosthetic implant is absolutely contraindicated in potentially infected operating fields through the review of literature and personal experience . MATERIALS AND METHODS: The authors performed ten prosthetic hernia repairs in potentially contaminated areas, with a preliminary preparation of the retromuscular-preperitoneal space hosting the prosthesis implant, and subsequent performance of the major operation . RESULTS: There were neither major nor minor complications with a 21-month follow-up (mean period) . DISCUSSION: It is certain that both in noncomplicated inguinal hernia and in abdominal wall hernia repairs, the use of antibiotics can significantly reduce the number of infections . It is very important to underline that the success of the described procedure can be guaranteed only by an accurate preparation of the preperitoneal space: perfect haemostasis, temporary closure of the space with the insertion of iodine gauzes and suturing the edges, local antibiotic treatment, washing of the cavity, and accurate drainage . CONCLUSIONS: Prosthetic repair is the gold standard for inguinal, incisional, and all abdominal wall hernias and should be used, with the method described, even in potentially contaminated areas . The use of a prosthesis has to be avoided in clearly infected cases.

BJOG, 2004 Jul, 111(7), 695 - 9
Antisepsis for abdominal hysterectomy: a randomised controlled trial of povidone-iodine gel; Eason E et al.; OBJECTIVE: To assess whether infectious morbidity after total abdominal hysterectomy is decreased by the addition of 20 cc povidone-iodine gel at the vaginal apex after the usual vaginal preparation with povidone-iodine solution . STUDY DESIGN: Randomised controlled trial . SETTING: Fifteen secondary and tertiary hospitals in Canada . SAMPLE: A total of 1570 women undergoing planned total abdominal hysterectomy . METHODS: Computer-generated randomisation using a centralised telephone service was stratified by study centre with variable block size . In the operating room, a swab for bacterial vaginosis was taken before vaginal antisepsis . Study group remained concealed until the standard surgical preparation in the operating room was complete . Then povidone-iodine gel 20 cc was placed at the vaginal apex in the intervention group only . Participants were followed for one month post-operative . MAIN OUTCOME MEASURES: The primary outcome was post-operative infectious morbidity during the 30 days after surgery, defined as: febrile morbidity with hospital stay greater than five days or antibiotic treatment, or infection requiring readmission to hospital or additional visit . Other outcomes included abdominal wound infection, pelvic abscess and other pelvic infections . RESULTS: Post-operative infectious morbidity within 30 days occurred in 128/780 (16%) women receiving povidone-iodine gel preparation and 142/790 (18%) women not receiving gel (RR 0.9, 95% CI 0.7 to 1.1) . Pelvic abscess was diagnosed in 0 patients in the gel group and in seven patients in the control group (P < 0.01) . No significant difference was found in pelvic cellulitis (eight in each group) or abdominal wound infection (51 in the gel group and 58 in the control group, P= 0.5) . CONCLUSION: Povidone-iodine vaginal gel antisepsis led to a 9% relative decrease in overall infectious morbidity after abdominal hysterectomy, which was not statistically significant . Povidone-iodine vaginal gel decreased the risk of pelvic abscess after total abdominal hysterectomy.

Br J Haematol, 2004 Jul, 126(1), 127 - 32
Efficacy and safety of two different rG-CSF preparations in the treatment of patients with severe congenital neutropenia; Carlsson G et al.; In patients with severe congenital neutropenia (SCN), the absolute neutrophil count (ANC) is raised during treatment with granulocyte colony-stimulating factor (G-CSF), resulting in a marked reduction of bacterial infection . Some patients, however, still have recurrent but less severe bacterial infections and severe periodontal infections . As it has been suggested that the biological activity of glycosylated recombinant human G-CSF (rHuG-CSF, i.e . lenograstim) is higher than the non-glycosylated form (i.e . filgrastim), we compared the two given in equimolar doses . Seven SCN patients participated in an open, randomized, double crossover study comprising 60 weeks, with four 12-week periods when the two drugs alternated after a 12-week run-in-period . The mean ANC values, sampled every second week, were 5.1 x 10(9)/l during filgrastim treatment and 4.2 x 10(9)/l during lenograstim treatment (P = 0.042) . The ANC levels were also significantly higher during filgrastim treatment, when comparing each complementary pair of ANC measurements (P = 0.011) as well as the mean ANC values during each 12-week treatment period (P = 0.033) . There were no differences regarding the frequency of infection, antibiotic treatment, gingival bleeding and the number of hospital admissions between the groups . We conclude that filgrastim and lenograstim displayed equal clinical efficacy, but that ANC levels were higher during filgrastim treatment, when administered in equimolar doses.

Scand J Infect Dis, 2004, 36(4), 316 - 8
Bartonella henselae causing severe and protracted illness in an otherwise healthy person; Schiellerup P et al.; Bartonella henselae is an emerging pathogen capable of causing severe disease . We report a case of severe protracted illness in an otherwise healthy police dog handler . The patient recovered slowly after antibiotic treatment . This case report emphasizes the importance of considering B . henselae infections in patients with fever of unknown origin.

Otolaryngol Head Neck Surg, 2004 Jun, 130(6), 712 - 7
Management of Ludwig's angina with small neck incisions: 18 years experience; Bross-Soriano D et al.; OBJECTIVE: To review Ludwig's angina medical and surgical approach with small incisions . STUDY DESIGN: Retrospective, open, noncomparative, longitudinal . METHODS: All patients with Ludwig's angina who received medical, metabolic, airway management, and surgical treatment from January 1, 1983 to December 31, 2000 . STUDIED PARAMETERS: Antibiotic treatment, surgical treatment, hospitalization time, associated diseases, etiologic factors, recuperation time . RESULTS: Age range was 18 to 87 years, with a female-to-male ratio of 1.1:1 (68 females, 53 males) . Thirty patients belonged to middle or high socioeconomic status . The primary site of infection was odontogenic in 107 of the patients . All the patients were managed with surgical drainage made within the first 12 hours after hospital admission . The most common antibiotic treatments were the combination of clindamycin with crystalline penicillin G . The hospital stay for more than half of patients was 6 days or less . In 62 patients we found extension into the parapharyngeal space and in 32 cases we found retropharyngeal extension of the Ludwig's angina . Forty-six patients had or were diagnosed as having diabetes mellitus . Tracheotomy was required in 34 patients . The airway of the rest of patients was controlled with nasotracheal intubation . Only 33 patients had major complications, such as mediastinitis, sepsis, or death . CONCLUSIONS: Drainage using small incisions is a safe and effective method as part of treatment of Ludwig's angina.

Am J Clin Hypn, 2004 Jan, 46(3), 239 - 45
Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriée; Shenefelt PD; Hypnotic suggestion successfully alleviated the behavioral picking aspect of acne excoriee des juenes filles in a pregnant woman who had been picking at the acne lesions on her face for 15 years . Acne excoriee is a subset of psychogenic or neurotic excoriation . Conventional topical antibiotic treatment was used to treat the acne . Compared with other treatments for uncomplicated acne excoriee, hypnosis is relatively brief and cost-effective and is non-toxic in pregnancy.

Int J Clin Pharmacol Ther, 2004 Feb, 42(2), 110 - 9
Alternative versus conventional treatment strategy in uncomplicated acute otitis media in children: a prospective, open, controlled parallel-group comparison; Wustrow TP; Otovowen Study Group; OBJECTIVES: Evidence from clinical trials questions the benefit-risk ratio of first-line antibiotic treatment for uncomplicated acute otitis media in childhood . Alternative treatment strategies are very popular but have not been the subject of larger controlled clinical trials . This trial compares an alternative with a conventional treatment strategy for acute otitis media . METHODS AND PATIENTS: 390 children aged 1-10 years presenting with uncomplicated acute otitis media participated in a prospective, open, non-randomized, controlled, parallel-group study . According to self-assignment of investigators, children were treated either conventionally (free combinations of decongestant nose drops, mucolytics, analgesics and antibiotics) or alternatively with Otovowen (fixed combination of plant-based tinctures and homeopathic potencies), supplemented by conventional medications when considered necessary . RESULTS: Alternatively treated patients (n = 192) had significantly less severe otoscopic findings and clinical symptom ratings at baseline than children treated in conventional centers (n = 193) . Patients cared for by conventional therapists took more antibiotics (80.5% vs . 14.4%; chi2-test, p < 0.001) and analgesics (66.8% vs . 53.2%; chi2-test, p = 0.007) . Times to recovery were 5.3 +/- 2.4 and 5.1 +/- 2.2 days for alternative and conventional treatment, respectively . Odds ratios (OR) with a lower limit of 1-sided 97.5% confidence interval (CI) were 0.98 (0.76), 0.95 (0.73) and 0.88 (0.69) for results adjusted to baseline otoscopy, pain and symptom score, respectively (Cox-Mantel test) . Absence from school or preschool nursery was 1.7 days in both groups; ORs (CI) were 1.00 (0.76), 0.96 (0.73) and 1.04 (0.80) . Noninferiority of alternative treatment (CI limit of OR above 0.696) was not proven for pain resolution (-5.2 vs . -5.8 score points); OR (CI) were 0.87 (0.68), 1.15 (0.87) and 0.74 (0.58) . Alternative treatment was judged both by doctors (Mann-Whitney estimator with 2-sided 95% CI 0.41 (0.35-0.47)) and parents (0.42 (0.36-0.48)), to be significantly better tolerated than conventional treatment . CONCLUSIONS: In primary care management of uncomplicated acute otitis media in childhood, an alternative treatment strategy based on the natural medicine, Otovowen may substantially reduce the use of antibiotics without disadvantage to the clinical outcome.

J Formos Med Assoc, 2004 Apr, 103(4), 311 - 3
Ludwig's angina following herpetic gingivostomatitis in a toddler with tetralogy of Fallot; Chen CJ et al.; Ludwig's angina is a rare but potentially lethal cellulitis of the submandibular space that occurs most often in young adults with predisposing odontogenic infection . In contrast to adult cases, most children with Ludwig's angina have no initiating factor . We report a case of Ludwig's angina in a 15-month-old boy which developed after an episode of herpetic gingivostomatitis . Under close monitoring of respiratory status, the condition was successfully managed with antibiotic treatment . This case illustrates that Ludwig's angina can develop in association with herpetic gingivostomatitis, which is a common and usually self-limited disease in pediatric patients . Prompt recognition and aggressive management of this rare and severe secondary bacterial infection are the keys to avoiding unnecessary morbidity and mortality.

Pediatr Pulmonol, 2004 Jul, 38(1), 43 - 9
Longitudinal study of oxidative status in 312 cystic fibrosis patients in stable state and during bronchial exacerbation; Lagrange-Puget M et al.; In cystic fibrosis (CF), there is an imbalance in the oxidant/antioxidant system, leading to oxidative damage . The aim of this study was to assess antioxidant-scavenger deficiencies and lipid peroxide variations in three clinical situations (stable status, acute exacerbation, and after intravenous antibiotic treatment) . The objective was also to correlate oxidative stress with age, nutritional status, and respiratory function . The study included prospectively 312 consecutive patients and 53 controls . Antioxidants (vitamin A, vitamin E, carotenoids, and glutathione) and oxidative markers (malondialdehyde and lipid peroxides) were measured in plasma . Regression analyses were performed . Antioxidant levels were lower in CF patients than in controls . These levels decreased during acute exacerbation and increased after antibiotic treatment . Carotenoid levels were not modified by infection or age . Only vitamin A and carotenoid levels were positively correlated to body mass index . Antioxidant levels were correlated to forced expiratory volume at 1 sec . Lipid peroxidation markers were lower in patients than in controls . Their levels decreased during infection, and increased after antibiotic treatment . Impaired lung function was correlated with elevated malondialdehyde levels . In conclusion, this study demonstrates antioxidant deficiency in a very large cohort of CF patients . Carotenoid and vitamin E deficiencies occur early in the course of the disease . Antioxidants decrease with bronchial infection . By contrast, nutritional disorders did not modify antioxidant levels during acute exacerbations . Thus, pulmonary disorders rather than nutritional disorders seem to be essential in the imbalance of the oxidant/antioxidant system . Results concerning glutathione and oxidative-marker levels highlighted the fact that their plasma values do not reflect oxidative stress in the respiratory tract .

Am J Kidney Dis, 2004 Jun, 43(6), e1 - 3
tuberculous otitis media in a renal transplant recipient; Ergun I et al.; Tuberculous otitis media is a rare cause of chronic suppurative infection of the middle ear and a very uncommon form of extrapulmonary tuberculosis . Although there have been several case reports in the nonimmunosuppressive population of tuberculous otitis media, it has never been reported in an immunosuppressed allograft recipient . We present a case of diagnosed tuberculous otitis media after recurrent chronic otitis media treated several times with empiric antibiotic treatment . After the patient developed postauricular fistula and underwent surgical removal of granulation tissue, the diagnosis was made on the basis of histopathology and growth in culture of Ziehl-Neelsen . Clinical response promptly followed institution of antituberculous treatment including isoniazid, rifampicin, ethambutol, and pyrazinamide.

Acta Neurochir (Wien), 2004 Jun, 146(6), 571 - 80; discussion 580 Epub 2004 Apr 13.
Neurosurgical management of orbital inflammations and infections; Schick U et al.; BACKGROUND: We present an overview of the treatment and clinical outcome of 22 orbital inflammations and infections, carried out in our center from 1991 to 2002 . METHOD: The surgical approach was determined by the location, and type of the lesion . Lateral orbitotomy was performed in 2 laterally located lesions, a transconjunctival approach in 8 medial, basal, extra-, intraconal lesions . Pterional intradural (5), and extradural (3) approaches were used in case of intracranial involvement or location in the orbital apex and optic canal . Lesions of the lid were operated via eyebrow incision . FINDINGS: Bacterial infections were confirmed in 5 cases (1 mucocele, 3 abscesses, 1 necrotizing inflammation) . 15 patients were diagnosed as chronic inflammatory pseudotumors, 6 of whom showed a granulomatous subtype, and 3 involvement of the optic nerve . All patients failed to reveal systemic disease and had a localized orbital inflammatory process . 7 of the patients responded rapidly to systemic corticosteroid treatment with no episodes of recurrence . 3 patients showed recurrence despite corticosteroids . CONCLUSIONS: Orbital infections are cured by antibiotic treatment . The course of inflammatory pseudotumor is variable and requires multidisciplinary treatment . Therapeutic options include surgical biopsy or debulking, corticosteroids, chemotherapy, and radiation therapy .

Dig Surg, 2004, 21(2), 161 - 3 Epub 2004 May 27.
Migratory necrolytic dermatitis presenting after cephalosporin administration in a patient with a pancreatic head mass; Gumbs AA et al.; Migratory necrotizing dermatitis is one of the most distressing presenting symptoms of glucagonomas . This rare functioning pancreatic endocrine tumor is third in incidence after insulinomas and gastrinomas and is often malignant at the time of diagnosis . Elevated serum glucagon levels cause decreased amino acid levels which is believed to be the principal cause of the dermatitis . Other symptoms include anemia, visual scotomata and mild diabetes mellitus . Medical treatment alone including octreotide and amino acid supplementation has been reported to eliminate the dermatitis . Nonetheless, surgical resection or debulking remains the definitive treatment when possible . Because of its rarity, diagnosis may be delayed by years accounting for the high rate of metastasis at presentation . Reported here is the case of a 77-year-old man who presented with a migratory necrotizing dermatitis after antibiotic treatment and whose diagnosis of a glucagonoma was then delayed for over 1 year .

Lancet, 2004 May 22, 363(9422), 1721 - 3
Drug intervention trials in sepsis: divergent results; Polderman KH et al.; CONTEXT: Important advances have been made in our understanding of severe sepsis . Outcome can be improved by targeted interventions, including early and appropriate antibiotic therapy and goal-directed resuscitation, and might be further improved by selective decontamination of the digestive tract, tight control of glucose, and possibly by giving corticosteroids to selected patients . Drugs that target specific steps in the septic cascade include cytokine inhibitors, anti-endotoxins, and the three naturally occurring anticoagulants . Only one of these trials, which assessed the efficacy of activated protein C, reported significant improvements in outcome . Translation of these results into practice has been hampered by high drug costs, and by apparent discrepancies between interim results and final outcomes in two of the trials with natural anticoagulants . STARTING POINT: Recently, Steven Opal and colleagues (Crit Care Med 2004; 32: 332-41) reported a randomised trial with platelet-activating-factor acetylhydrolase to suppress the inflammatory response in septic patients . No effects on outcome were observed (mortality 24% with placebo vs 25% with the intervention) . By contrast, Jose Garnacho-Montero and colleagues, in a cohort study (Crit Care Med 2003; 31: 2742-51), saw large mortality reductions with initially appropriate choice of antibiotics in septic patients (19.8% reduction overall and 43.4% in patients with septic shock) . These benefits were higher than those even in the most successful trial with an antisepsis agents, underscoring the importance of basic measures in severe sepsis . WHERE NEXT? Initial management in severe sepsis should include early goal-directed fluid resuscitation, appropriate antibiotic treatment, and surgical-site control . Intensive-care units should be run by specialists, with adequate medical and nursing staffing . Tight regulation of glucose, selective decontamination of the digestive tract, and moderate-dose corticosteroids in selected cases should be considered . Expensive new drugs, such as activated protein C, might further improve outcome, but should be considered only when organisational aspects and supportive care have been optimised.

Clin Infect Dis, 2004 May 15, 38(10), 1383 - 90 Epub 2004 Apr 29.
Quantifying uncertainty: physicians' estimates of infection in critically ill neonates and children; Fischer JE et al.; To determine the diagnostic accuracy of physicians' prior probability estimates of serious infection in critically ill neonates and children, we conducted a prospective cohort study in 2 intensive care units . Using available clinical, laboratory, and radiographic information, 27 physicians provided 2567 probability estimates for 347 patients (follow-up rate, 92%) . The median probability estimate of infection increased from 0% (i.e., no antibiotic treatment or diagnostic work-up for sepsis), to 2% on the day preceding initiation of antibiotic therapy, to 20% at initiation of antibiotic treatment (P<.001) . At initiation of treatment, predictions discriminated well between episodes subsequently classified as proven infection and episodes ultimately judged unlikely to be infection (area under the curve, 0.88) . Physicians also showed a good ability to predict blood culture-positive sepsis (area under the curve, 0.77) . Treatment and testing thresholds were derived from the provided predictions and treatment rates . Physicians' prognoses regarding the presence of serious infection were remarkably precise . Studies investigating the value of new tests for diagnosis of sepsis should establish that they add incremental value to physicians' judgment.

Am J Rhinol, 2004 Mar-Apr, 18(2), 93 - 8
Myeloperoxidase in nasal secretion as a cell-activation marker in acute sinusitis; Haxel BR et al.; BACKGROUND: Acute bacterial infections of the upper respiratory tract, including the nasal sinuses, lead to an activation of neutrophil granulocytes . The protein myeloperoxidase (MPO) is released by this cell type only and therefore can act as a marker for activity of inflammation . METHODS: In a prospective multicenter study, 45 patients with acute bacterial sinusitis (diagnosed by clinical examination, ultrasonography, and X ray or computed tomography scan) were treated with two different antibiotics (Cefditoren or Cefuroxim twice a day for 10 days) . Nasal secretions were collected with absorbing foam-rubber samplers and a concentration of MPO was evaluated before the therapy and after 7 +/- 1 days and 14 +/- 2 days of antibiotic treatment . The concentrations of MPO were measured by a radioimmunoassay method and the dilution factors were determined by the lithium method . RESULTS: Significant differences in the MPO concentration in nasal secretions between the first and third visit could be found in both groups (p < 0.01 each) . No significant difference was seen within the two different antibiotics used . CONCLUSION: Measurement of MPO concentration in nasal secretions showed a significant change after antibiotic treatment of acute bacterial rhinosinusitis . The reduction of MPO levels correlated with the observed clinical and radiological improvement of the disease . Additional investigations are needed to achieve more knowledge about basal concentrations of MPO in healthy persons and different activation patterns before it can be determined whether the MPO measurement could be a suitable method for monitoring the success of an antibiotic treatment in acute bacterial sinusitis.

Zhonghua Nan Ke Xue, 2004 Apr, 10(4), 275 - 7, 281
{Related pathogen examinations and therapeutic choices for chronic prostatitis following sexually transmitted diseases}; Zhang W et al.; OBJECTIVE: To explore the etiologic relationship between sexually transmitted diseases(STDs) and chronic prostatitis (CP), and to evaluate the effect of multiple treatment on CP following STDs . METHODS: Seventy-two cases of CP after STDs were randomly divided into three groups: Group A (treated with levefloxatin), Group B (treated with Levofloxacin, terazosin and microwave), and Group C (treated with levofloxacin, Chinese traditional medicine and microwave), all treated for thirty days . The pathogens related to STDs in the prostatic fluid of all the patients had been examined before treatment . The efficacy was evaluated among the three groups by comparing the count of leukocytes and the scores of NIH-CPSI before and after treatment . RESULTS: The pathogens related to STDs were found in the prostatic fluid of 7 patients . The count of leukocytes and the scores of NIH-CPSI decreased after treatment in the three groups, more markedly in Groups B and C than in Group A . CONCLUSION: There is no strict etiological causality between STDs and CP . Multiple treatments are superior to single antibiotic treatment.

Am J Surg, 2004 May, 187(5A), 25S - 28S
The use of antibiotics in the diabetic foot; Edmonds M et al.; Lower limb infections are the most common indication for hospital admission in patients with diabetes . However, diagnosis of infection can be delayed because the normal clinical signs are often absent in patients with diabetes . The proper use of antibiotics in the treatment of the diabetic foot remains contested: one view is to administer antibiotics only in the presence of clinical infection; the other one is to give antibiotics freely to all patients with ulcers . This review of literature includes 2 controlled studies of antibiotics in diabetic foot ulcers . The first study showed no advantage from amoxicillin plus clavulanate as a supplement to standard therapy in uncomplicated ulcers . Patients (N = 44) with neuropathic ulcers (some of whom had cellulitis) were randomized to oral amoxicillin plus clavulanate or matched placebo . At 20 days' follow-up, there was no significant difference in outcome between the 2 groups . A further investigation (N = 64) compared ulcer patients who received oral antibiotics with those who did not . In the group with no antibiotics, 15 patients developed clinical infection, whereas none did in the antibiotic group (P <0.001) . Seven patients in the nonantibiotic group needed hospital admission and 3 patients came to amputation . In the nonantibiotic group, 11 of 15 with infection had a positive swab compared with 1 of 17 without infection (P <0.01) . In the nonantibiotic group, 17 patients healed, compared with 27 in the antibiotic group (P <0.02), with significantly more ischemic patients healing in the antibiotic group (P <0.01) . Patients with diabetes who have clean ulcers associated with peripheral vascular disease and positive ulcer swabs should be considered for early antibiotic treatment . The diabetic foot is highly susceptible to repeat ulceration, and diabetic ulcers are more prone to infection than other ulcers . Furthermore, untreated infection can lead to amputation . This cycle can be broken only with aggressive treatment.

Recenti Prog Med, 2004 Mar, 95(3), 149 - 52
{Pyogenic sacroiliitis complicated by iliopsoas muscle abscess}; Gabrielli GB et al.; Both pyogenic sacroiliitis and iliopsoas muscle abscess are uncommon infectious entities, and their coexinstence has been reported in very few patients . We present here the case of a woman who developed a large iliopsoas abscess as a consequence of a pyogenic sacroiliitis, initially misdiagnosed as a common sciatica and treated with corticosteroids . The patient was cured by the surgical drainage of the abscess and a long-lasting antibiotic treatment . We discuss diagnostic difficulties linked to the two infectious entities, their possible pathogenic connections, the role of imaging procedures, and therapeutic options . We conclude that pyogenic sacroiliitis and the potential evolution to an iliopsoas abscess must be taken into consideration in the differential diagnosis of lower back pain, especially if fever is a concomitant sign.

Am J Emerg Med, 2004 May, 22(3), 214 - 8
Hepatic portal venous gas: clinical significance of computed tomography findings; Hou SK et al.; Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance . Most cases with HPVG are related to mesenteric ischemia that have been associated with extended bowel necrosis and fatal outcome . With the help of computed tomography (CT) in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia has improved . There has been also an increasing rate of detection of HPVG with certain nonischemic conditions . In this report, we present two cases demonstrating HPVG unrelated to mesenteric ischemia . One patient with cholangitis presented abdominal pain with local peritonitis and survived after appropriate antibiotic treatment . Laparotomy was avoided as a result of lack of CT evidence of ischemic bowel disease besides the presence of HPVG . The other case had severe enteritis . Although his CT finding preluded ischemic bowel disease, conservative treatment was implemented because of the absence of peritoneal signs or clinical toxic symptoms . Therefore, whenever HPVG is detected on CT, urgent exploratory laparotomy is only mandatory in a patient with whom intestinal ischemia or infarction is suspected on the basis of radiologic and clinical findings . On the other hand, unnecessary exploratory laparotomy should be avoided in nonischemic conditions that are usually associated with a better clinical outcome if appropriate therapy is prompted for the underlying diseases . Patients with radiographic diagnosis of HPVG should receive a detailed history review and physical examination . The patient's underlying condition should be determined to provide a solid ground for exploratory laparotomy . A flow chart is presented for facilitating the management of patients with HPVG in the ED.

Chest, 2004 May, 125(5), 1791 - 9
A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia; Micek ST et al.; OBJECTIVE: To evaluate an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia (VAP) . DESIGN: Prospective, randomized, controlled clinical trial . SETTING: A medical ICU from a university-affiliated urban teaching hospital . PATIENTS: Between April 2002 and July 2003, 290 patients completed the clinical trial . INTERVENTIONS: Patients were assigned to have the duration of antibiotic treatment for VAP determined by an antibiotic discontinuation policy (discontinuation group) or their treating physician teams (conventional group) . RESULTS: Severity of illness using APACHE (acute physiology and chronic health evaluation) II score (22.8 +/- 9.0 vs 23.2 +/- 9.4, p = 0.683) {mean +/- SD} and the clinical pulmonary infection score (7.1 +/- 0.9 vs 7.2 +/- 0.9, p = 0.222) were similar for both patient groups . The duration of antibiotic treatment for VAP was statistically shorter among patients in the discontinuation group compared to patients in the conventional antibiotic management group (6.0 +/- 4.9 days vs 8.0 +/- 5.6 days, p = 0.001) . The occurrence of a secondary episode of VAP was not statistically different between these two groups (17.3% vs 19.3%, p = 0.667) . Hospital mortality (32.0% vs 37.1%, p = 0.357) and ICU length of stay (6.8 +/- 6.1 days vs 7.0 +/- 7.3 days, p = 0.798) were also statistically similar . CONCLUSIONS: The application of an antibiotic discontinuation policy for clinically suspected VAP was associated with a decrease in the overall duration of antibiotic treatment . These findings suggest that shorter courses of empiric antibiotic therapy for patients treated for clinically suspected VAP can be safely achieved.

J Clin Epidemiol, 2004 Apr, 57(4), 429 - 34
Back-up antibiotic prescriptions could reduce unnecessary antibiotic use in rhinosinusitis; Martin CL et al.; OBJECTIVES: To examine the attitudes of patients with rhinosinusitis toward the availability of "back-up" antibiotics, and potential implications for antibiotic use rates . STUDY DESIGN AND SETTING: A survey that assessed actual and hypothetical antibiotic prescription patterns was administered to a convenience sample of patients treated for rhinosinusitis in one acute care facility between September 1 and December 1, 2001 . RESULTS: Of 386 eligible patients, 114 completed the survey . Seventy-six percent of patients expected antibiotic treatment; satisfaction rates were significantly associated with receiving an antibiotic prescription (P <.05) . Over two-thirds of patients (69.7%) reported preference for back-up antibiotic prescriptions in the future, with 91.1% stating they would wait at least 1 day, and 52.7% at least 7 days, to fill a backup prescription . In sensitivity analysis, back-up prescriptions significantly reduced antibiotic use over a wide range of assumptions . CONCLUSIONS: The majority of patients with rhinosinusitis in this study expected antibiotic prescriptions, and were more satisfied if they were received . Back-up antibiotics have the potential to reduce unnecessary antibiotic use, mitigate risk of nontreatment, and preserve high levels of patient satisfaction.

Acta Orthop Traumatol Turc, 2004, 38(2), 136 - 44
{Low back pain among children and adolescents}; Bezer M et al.; OBJECTIVES: We presented our experience with the diagnosis and treatment of low back pain in children . METHODS: We retrospectively reviewed 29 children (15 girls, 14 boys; mean age 12 years; range 9 to 17 years) who were treated for low back pain and had appropriate follow-ups . Etiologic causes were sought by clinical evaluation, radiologic studies, and laboratory tests . Patients with unknown etiology underwent symptomatic treatment . The mean follow-up period was 42 months (range 12 to 96 months) . RESULTS: Etiology was determined in 26 patients (89%), which included spondylolysis/spondylolisthesis (n=8), Scheuermann's disease (n=6), neoplasia (n=5), discitis/vertebral osteomyelitis (n=4), and lumbar disc herniation (n=3) . Spondylolysis was managed conservatively, except for one patient who had in situ spinal fusion for associated spondylolisthesis . Five patients with Scheuermann's disease were treated conservatively, while one patient required spinal fusion . Surgical treatment with biopsy, curettage, and bone grafting was performed for all neoplasias, but one which was followed-up conservatively . Two patients with discitis were managed with antibiotic treatment and two patients with vertebral osteomyelitis (Pott's abscess) underwent both medical treatment and surgical drainage and stabilization with strut graft . Lumbar disc herniation was treated conservatively in two patients, while one had surgical treatment with excision of disc fragments and limited laminectomy . Finally, all the patients became asymptomatic on final examinations . CONCLUSION: Serious consideration should be given to persistent low back pain in children . Clinical, radiologic, and laboratory findings can be elaborated into etiologic diagnoses and complete relief can be achieved with appropriate treatment.

Fam Pract, 2004 Jun, 21(3), 234 - 7
Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction; Welschen I et al.; BACKGROUND: GPs often assume that prescribing antibiotics increases patient satisfaction . OBJECTIVE: The purpose of this study was to determine the associations between receiving antibiotics and information/reassurance on the one hand and patients' satisfaction on the other in patients with acute respiratory tract symptoms, and to assess whether this relationship is influenced by patients' expectations . METHODS: Questionnaires were distributed among patients presenting with acute respiratory tract symptoms in 51 general practices (122 GPs) in the region of Utrecht, The Netherlands . Outcome measures were patients' expectations, GPs' management regarding antibiotic prescribing and information/reassurance, and patient satisfaction . RESULTS: Information/reassurance was expected by 90% of the respondents (916/1014); 97% of those actually received it (888/916) . Fifty percent expected antibiotics (467/926), while 73% of them received antibiotics (343/467) . Receiving information/reassurance was more strongly associated with satisfaction than an antibiotic prescription {adjusted odds ratio (OR) 10.6; 95% confidence interval (CI) 5.6-20.1, and adjusted OR 2.2; 95% CI 1.3-3.8, respectively} . Patients' expectations towards antibiotics modified these associations; in patients not expecting antibiotics, receiving information/reassurance was the only independent determinant of satisfaction (adjusted OR 21.6; 95% CI 7.4-62.7) and in patients who expected antibiotics, actually receiving antibiotics and receiving information/reassurance were equally important determinants of satisfaction (adjusted OR 3.8; 95% CI 1.9-7.5, and adjusted OR 4.7; 95% CI 1.9-11.9, respectively) . CONCLUSION: GPs should first explore patients' expectations about antibiotic treatment before giving information about the self-limitedness of respiratory tract symptoms and (in)effectiveness of antibiotics in order to enhance shared decision making and rationalize antibiotic prescribing.

Neuropediatrics, 2004 Apr, 35(2), 134 - 8
Acquired torticollis due to Grisel's syndrome: case report and follow-up of non-traumatic atlantoaxial rotatory subluxation; Wurm G et al.; Non-traumatic atlantoaxial rotatory subluxation is an uncommon entity, with inconsistent presentations . It is also known as Grisel's syndrome (GS), and most commonly follows infectious processes of the upper respiratory tract . A case is described of a non-traumatic rotatory atlantoaxial dislocation in a three-year-old boy . The patient presented with acute torticollis one week after mild upper respiratory infection . Neurological evaluation and lumbar punction were normal . After five days of intractable pain and non-reducible rotational tilt of the head to the left, CT and MR imaging were performed and showed atlantoaxial rotatory subluxation . In addition, MRI demonstrated middle ear and mastoid inflammation . Tilt reduction could be obtained through gentle skull traction under sedation and relaxation for 3 days . Antibiotic treatment was performed . The patient was then placed in a Minerva cast jacket . After seven weeks of immobilization, CT demonstrated regular atlantoaxial alignment . Follow-up after 5.5 years showed the boy neurologically intact and free of clinical complaints . Dynamic cervical radiographs confirmed that the atlantoaxial joints were stable.

Am J Ophthalmol, 2004 May, 137(5), 940 - 2
Acute acquired toxoplasma retinitis may present similarly to unilateral acute idiopathic maculopathy; Lieb DF et al.; PURPOSE: To describe a patient with acquired toxoplasma retinitis that shared similarities with unilateral acute idiopathic maculopathy . DESIGN: Interventional case report . METHODS: Interventional case report . RESULTS: A 39-year-old woman presented with sudden unilateral vision loss in the right eye after a flu-like illness . She had retinitis involving the fovea, subretinal fluid, thickening of the retinal pigment epithelium, and a few vitreous cells; the retinitis resolved with antitoxoplasma antibiotic treatment . CONCLUSIONS: Acute acquired toxoplasma retinitis may present similarly to unilateral acute idiopathic maculopathy.

Spine J, 2004 May-Jun, 4(3), 312 - 6
Pulmonary complications in anterior-posterior thoracic lumbar fusions; Jules-Elysee K et al.; BACKGROUND CONTEXT: Surgery for adult spinal deformity may require both an anterior and posterior approach in order to stabilize the spine and achieve the desired correction . These procedures can be associated with significant pulmonary complications, including atelectasis, pneumonia and respiratory failure . The etiology of some of the respiratory complications is clear: poor inspiratory effort from incision pain and previous pulmonary disease . However, for many patients the direct cause of these complications is not obvious . PURPOSE: To delineate the incidence, severity and risks associated with pulmonary complications in the setting of major spine surgery . STUDY DESIGN/SETTING: Retrospective chart review study of adult patients undergoing combined anterior-posterior thoracic, lumbar and sacral fusion spine surgery . PATIENT SAMPLE: A total of 60 charts were reviewed for this study . OUTCOME MEASURES: Radiographic abnormalities correlated with clinical findings, postoperative need for ventilation and lengths of hospital stay were used as outcome measures . METHODS: Perioperative pulmonary complications were assessed for 60 patients with spinal deformities who underwent combined anterior-posterior thoracic, lumbar and sacral fusion over a 2-year period . RESULTS: One patient was eliminated from analysis because of multiple surgeries during his hospital course . Of the remaining 59 patients, 38 (64%) developed roentgenographic abnormalities . The most common radiographic finding was an effusion found in 66% of these patients, followed by atelectasis in 53% . Twenty-one percent (8 of 38) had infiltrates . Five (5 of 38) or 13% had evidence of partial or complete lobar collapse; in two bronchoscopy was required because of profound hypoxemia . Two patients had pneumonia requiring antibiotic treatment . All but two patients were extubated within 36 hours of surgery . They were kept intubated because of hemodynamic instability . There was no statistically significant difference in the group of patients with and without roentgenographic abnormalities with regard to age, weight, American Society of Anesthesiologists class, smoking history, pulmonary function test results, blood loss, perioperative blood and crystalloid requirement and length of surgery . Patients with radiographic abnormalities were more likely to have had invasion of their thoracic cavity (p=.02) and had a longer mean hospital stay of 13.5 versus 10.2 days (p=.009) . CONCLUSION: Radiographic abnormalities of the lungs are common after major spine surgery involving both an anterior and posterior approach, especially when the thoracic cavity is invaded . In view of the morbidity and longer hospital stay associated with such findings, close monitoring of pulmonary status with aggressive pulmonary toilet are indicated.

Vaccine, 2004 May 7, 22(15-16), 1886 - 91
Evaluation of diphtheria convalescent patients to serve as donors for the production of anti-diphtheria immunoglobulin preparations; Bissumbhar B et al.; AIMS: The study was conducted to evaluate the possibility of selecting convalescent diphtheria patients to serve in emergency situations as donors for the production of anti-diphtheria immunoglobulin . To select suitable donors, the criterion of an antitoxin titer >/=3.0 IU/ml was used . In addition, the effects of treatment and the effect of immunization with diphtheria toxoid on the level of anti-diphtheria toxin antibodies were evaluated . SCOPE: Three groups of diphtheria patients were included in the study . The first group (n = 23) consisted of patients who had a basic antibiotic treatment, with or without serotherapy using horse antitoxin and/or human immunoglobulin . The second group (n = 12) comprised patients examined immediately after the onset of disease . The immunological history of this group was not known . The third group (n = 20) included patients with a known immunization history, treated only with antibiotics but having received a booster immunization with diphtheria toxoid . Antitoxin titers were measured using the toxin binding inhibition (ToBI) assay . CONCLUSIONS: In the first group, 47.8% (11/23) of the patients had a diphtheria antibody titer >/=3.0 IU/ml . For most of them, however, the antibody titers could have resulted from treatment with exogenous antibodies from horse antitoxin or human immunoglobulin (18/23) . Only two of the 11 high-titer subjects had received antibiotics only . Among the second group, only two (16.76%) of the patients had an antibody titer of >/=3.0 IU/ml . In the third group 50% (10/20) of the patients showed an antibody titer of >/=3.0 IU/ml prior to vaccination, and therefore could be directly considered as donors . Three weeks after booster vaccination, 70% (14/20) had an antibody titer of >/=3.0 IU/ml and 1 year after booster vaccination, 28.6% (2/7) of the subjects still had titers of >/=3.0 IU/ml . In 40% of these patients, a decrease was observed 3-4 weeks after the booster dose . It was concluded that convalescent diphtheria patients could be considered as donors in an emergency situation, since approximately half of them showed antitoxin titers of >/=3.0 IU/ml.

Scand J Infect Dis, 2004, 36(3), 213 - 8
Excessive use of rapid tests in respiratory tract infections in Swedish primary health care; Engstrom S et al.; A 1-y retrospective study of problem oriented electronic patient records, for encounters concerning respiratory tract infection, was performed . The aim was to analyse the management of respiratory tract infections in primary health care in terms of diagnostic coding, tests and antibiotic treatment using data from electronic patient records . 12 primary health care centres with a registered population of 102,050 residents in 3 counties in southeast Sweden participated . Data were retrieved electronically from records of patient encounters concerning respiratory tract infections . The data were: patient age and gender, date of contact, diagnostic code, CRP and GABHS tests and results, as well as antibiotic prescriptions . In a total of 19,965 encounters, the most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%) . A total of 4445 GABHS tests (in 22% of encounters) and 6141 CRP tests (31%) were performed, and both tests were done in 1910 encounters (10%) . A total of 7934 antibiotic prescriptions were registered . The proportion of patients tested and prescribed an antibiotic varied greatly between centres . We found an excessive, and much varying, use of rapid tests in encounters for respiratory tract infections . Data retrieval from electronic patient record systems was a feasible method to study the use of laboratory tests in relation to pharmacological treatment.

Dermatology, 2004, 208(3), 284 - 6
Fulminant herpetic sycosis: atypical presentation of primary herpetic infection; Campanelli A et al.; Fulminant herpetic sycosis is a rare but well-known manifestation of herpes simplex virus (HSV) infection occurring in the context of viral recurrence in immunodepressed patients . We present here the case of a 32-year-old male patient, without notable medical history, who developed papulovesicular lesions of the beard accompanied by fever, painful cervical lymphadenopathy and odynophagia, with a clinical evolution that was initially unfavourable under antibiotic treatment . The diagnosis of herpetic sycosis was established by means of direct immunofluorescence and culture which confirmed positivity for HSV-1 and serologies compatible with a primary viral infection . No sign for a latent immune deficit was found at the time of investigations . The clinical evolution was rapidly favourable with administration of intravenous aciclovir for 1 week . To our knowledge, herpetic sycosis as a presentation of primary viral infection has not been reported previously . The possibility of a herpetic sycosis of the beard must be considered in the case of non-response to antibiotic or antifungal treatment .

Dermatology, 2004, 208(3), 259 - 61
Subcutaneous infection with Mycobacterium abscessus in a renal transplant recipient; Prinz BM et al.; Transplant recipients show a high incidence of infections, often with atypical manifestations mainly because of drug-related immunosuppression . Mycobacterial infections can be life-threatening in immunosuppressed patients due to the risk of dissemination . There have been only few reports of cutaneous infections with Mycobacterium abscessus among immunosuppressed patients . We present a rare case with a sporotrichoid skin infection with M . abscessus in a renal recipient . The value of immunohistochemical detection of mycobacteria using an anti-BCG antibody in the diagnostic work-up skin biopsies is demonstrated . Long-term antibiotic treatment resulted in complete remission, although recurrences with atypical presentation were observed .

Circulation, 2004 May 4, 109(17), 2097 - 102 Epub 2004 Apr 26.
Serum antibodies against Chlamydia pneumoniae outer membrane protein cross-react with the heavy chain of immunoglobulin in the wall of abdominal aortic aneurysms; Lindholt JS et al.; BACKGROUND: Chlamydia pneumoniae (Cp) has been demonstrated in arteries and abdominal aortic aneurysms (AAAs) . However, the validity of the methods used is questioned, and antibiotic treatment trials have thus far shown disappointing results . Nevertheless, antibodies against the Cp outer membrane proteins (OMPs) have been associated with progression of atherosclerosis and AAAs . The aim of this study was to detect Cp OMPs in the wall of AAA patients by use of purified serum antibodies directed against Cp OMP and to assess potential cross-reacting proteins in AAA walls . METHODS AND RESULTS: Seventeen patients undergoing infrarenal AAA repair were studied . Full AAA thickness tissue was collected from the anterior wall of the aneurysm . Anti-OMP was extracted from seropositive AAA patients by use of an ELISA kit (Labsystems) . Analysis was performed by use of 2D polyacrylamide gel electrophoresis, immunoblotting, and mass spectrometric protein identification . OMP antigens were not detected in 16 of 17 AAA walls . However, 3 major AAA proteins cross-reacted with anti-OMP . The proteins were all identified as heavy chains of human immunoglobulin . CONCLUSIONS: We could not find evidence of Cp OMP in 16 of 17 AAA walls, but instead, all samples showed a strong cross-reaction between Cp OMP antibodies and human immunoglobulin . This might indicate that AAA is an autoimmune disease, perhaps triggered by an initial Cp infection.

Int J STD AIDS, 2004 May, 15(5), 328 - 32
Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin; Smith NH et al.; The objective of this prospective pilot study was to evaluate the response of HIV-infected patients with asymptomatic syphilis to one of two intensive antibiotic treatment regimens . Thirty-one HIV-infected patients with serum rapid plasma reagin titre > or =1:4 and no clinical findings of syphilis were randomized to receive daily intramuscular injections of ceftriaxone or procaine penicillin (plus oral probenecid) for 15 days; 24 returned for follow-up study . Seven of 10 (70%) procaine penicillin-treated patients and 10 of 14 (71%) ceftriaxone-treated patients had a > or =4-fold decline in RPR (P=0.94); two penicillin-treated and one ceftriaxone-treated patient relapsed . Two patients failed ceftriaxone therapy . Three penicillin-treated, and two ceftriaxone-treated patients were serofast . Serological responses were similar in those patients with and without asymptomatic neurosyphilis . There was no difference in the serologic response to daily treatment with ceftriaxone vs that with procaine penicillin plus probenecid; both treatments were associated with comparatively high rates of serological non-response and relapse.

Trop Med Int Health, 2004 May, 9(5), 644 - 50
Maternal perceptions of acute respiratory infections in children under 5 in rural South Africa; Kauchali S et al.; OBJECTIVES: To assess maternal ability to recognize respiratory distress and to identify local beliefs and practices around respiratory infections in rural KwaZulu/Natal, South Africa . METHODS: A descriptive study: 15 knowledgeable mothers were shown a video of 10 children with respiratory distress and four normal children . Mothers were asked to describe perceived types, signs, symptoms, causes of and actions taken for each child . Sensitivity and specificity were calculated for maternal recognition of respiratory distress (chest indrawing, fast breathing) shown on the video . A focus group discussion with six mothers was held to corroborate and refine individually reported local concepts . FINDINGS: Maternal recognition of respiratory distress was good (sensitivity 91.3%, 95% CI: 86.8-95.8%; specificity 95%, 95%CI: 89.5-100%), with little variation between mothers (kappa = 0.704) . Mothers described 12 'local types of respiratory illness', each with its own name and its own well-defined set of signs and symptoms . They were classifiable into five causative categories: supernatural, natural, tuberculosis, cold weather and unknown, indicating that perceptions of causation differed greatly from biomedical concepts . For illnesses of perceived supernatural causation, mothers were reluctant to seek medical care and antibiotics were deemed inappropriate . Traditional remedies were preferred instead . CONCLUSION: Knowledge of local vocabulary and concepts about respiratory infections is essential to design strategies for health care workers to communicate with mothers about respiratory disease, so that mothers will seek timely medical care, provide continued safe, supportive home care and comply with antibiotic treatment.

Harefuah, 2004 Apr, 143(4), 277 - 82, 318, 317
{Changing the therapeutic approach to acute otitis media in children}; Grossman Z et al.; Acute Otitis Media (AOM) is the most common reason for pediatrician's visits and for antibiotic prescription in childhood . A significant rise in bacterial resistance to antibiotic treatment has been detected in recent years . Accordingly, the attitude towards antibiotic treatment for AOM has been re-evaluated . Due to various difficulties in ear examination, physicians overdiagnosis Otitis Media with Effusion (OME) as AOM, leading to unnecessary prescription of antibiotics . The natural history of AOM shows spontaneous improvement without complications . Studies that have examined antibiotic treatment versus placebo in AOM have shown only minimal advantage for the antibiotic therapy in symptom reduction . Critical appraisal of the literature according to Evidence-based Medicine (EBM) criteria has led to several meta-analyses that showed only a minor advantage for antibiotics over placebo in AOM . In the Netherlands, the approach to AOM is that of delayed prescribing: symptomatic therapy is given for the first 24-72 hours and an antibiotic drug is prescribed only if symptoms persist after this initial period . This review examines the difficulties in reaching an accurate diagnosis of AOM and describes the natural history of AOM and evaluates the studies and meta-analyses comparing antibiotics to placebo . The Dutch approach to AOM will be discussed as an option and a recommended basis for reduction in antibiotic prescriptions for AOM.

Eur J Clin Microbiol Infect Dis, 2004 May, 23(5), 393 - 5 Epub 2004 Apr 27.
Severe peritonitis due to Balantidium coli acquired in France; Ferry T et al.; The case reported here concerns an alcoholic pork-butcher who presented with severe colitis with peritonitis, caused by the only ciliate protozoan capable of infecting humans, Balantidium coli . This parasite is common in a variety of domestic and wild mammals, mainly pigs; however, its prevalence rate in humans is very low--particularly in industrialised, northern countries, including France . The infection is most frequently acquired by ingesting food or water contaminated by pig faeces, and it may be asymptomatic or may cause acute diarrhoea . Specific antibiotic treatment is efficacious, and it is important to consider the risk of this parasitic disease in susceptible patients presenting with bloody diarrhoea.

Intensive Care Med, 2004 Aug, 30(8), 1544 - 51 Epub 2004 Apr 27.
Antibiotic-mediated release of tumour necrosis factor alpha and norharman in patients with hospital-acquired pneumonia and septic encephalopathy; Eggers V et al.; OBJECTIVE: To investigate antibiotic-mediated release of tumour necrosis factor (TNF)-alpha and norharman in patients with hospital-acquired pneumonia with and without additional septic encephalopathy . DESIGN: Prospective observational study with a retrospective post hoc analysis . SETTING: Surgical intensive care unit (ICU) at a university hospital . PATIENTS: Thirty-seven patients were consecutively included (9 patients with hospital-acquired pneumonia, 11 patients with hospital-acquired pneumonia and septic encephalopathy, 17 control patients) in the study . Pneumonia was defined according to the criteria of the American Thoracic Society . INTERVENTIONS: Patients received cephalosporins for antibiotic treatment of hospital-acquired pneumonia . Blood samples were taken before, immediately after and 4 h after application of cephalosporins . MEASUREMENTS AND RESULTS: Of the pneumonia patients, 55% developed septic encephalopathy . ICU stay, complications and mortality were significantly increased . An increased release of TNF-alpha was immediately seen in all pneumonia patients after antibiotics compared to controls, whereas the level did not differ between patients with and without septic encephalopathy . Norharman was significantly increased in pneumonia patients 4 h after antibiotic treatment, in tendency more enhanced in the pneumonia patients without encephalopathy . CONCLUSIONS: Patients with hospital-acquired pneumonia and septic encephalopathy had a significantly longer ICU stay with higher mortality rate compared to patients with hospital-acquired pneumonia alone . Antibiotic-mediated TNF-alpha release may induce the kynurenine pathway . TNF-alpha activates indolamine-2,3-dioxygenase with neurotoxic quinolinic acid as the end product . Norharman seems to counteract this mechanism and seems to play a role in neuroprotection . The worse outcome of patients with encephalopathy expresses the need to investigate protective factors and mechanisms.

Int J Infect Dis, 2004 May, 8(3), 155 - 62
Infective complications according to duration of antibiotic treatment in acute abdomen; Gleisner AL et al.; INTRODUCTION: Adjuvant antibiotic therapy for acute abdominal conditions is widely used . Its timing, duration, dose and spectrum, however, are not homogeneous amongst surgeons and prolonged courses are often used despite the unproven benefits of this practice . OBJECTIVE: To evaluate use and compare duration of antibiotic treatments in acute abdominal surgery . METHODS: Retrospective cohort study . The medical records of 290 patients who underwent operations for acute abdomen from July 1998 to July 1999 in a teaching hospital were reviewed . The pattern of antibiotic use and rates of postoperative complications were evaluated, along with surgical diagnosis, degree of contamination/infection, and incidence of postoperative complications . The patients were stratified according to the degree of contamination/infection noted during the operation . The study population was divided in two groups according to the duration of antibiotic use (cut-off point at the median antibiotic use in days, for each group of contamination/infection degree), and outcomes were compared . RESULTS: The degree of contamination/infection was significantly associated with an increased risk of wound infection, intra-abdominal abscess, postoperative infective complications and overall postoperative complications (p < 0.001) . A long course of antibiotics was not associated with lower infective complication rates . CONCLUSIONS: Shorter courses of antibiotic therapy based on the degree of contamination/infection seem to be safe . A prospective study should confirm this hypothesis.

Emerg Infect Dis, 2004 Mar, 10(3), 497 - 500
Human metapneumovirus-associated atypical pneumonia and SARS; Chan PK et al.; Acute pneumonia developed in a previously healthy man during the outbreak of severe acute respiratory syndrome (SARS) in southern China in March 2003 . Antibiotic treatment was ineffective, and he died 8 days after illness onset . Human metapneumovirus was isolated from lung tissue . No other pathogen was found . Other etiologic agents should thus be sought in apparent SARS cases when coronavirus infection cannot be confirmed.

Cochrane Database Syst Rev . 2004;(2):CD003261.
Interventions for impetigo; Koning S et al.; BACKGROUND: Impetigo is a common superficial bacterial skin infection, most frequently encountered in children . There is no standard therapy and guidelines for treatment differ widely . Treatment options include many different oral and topical antibiotics as well as disinfectants . OBJECTIVES: To assess the effects of treatments for impetigo, including waiting for natural resolution . SEARCH STRATEGY: We searched the Skin Group Specialised Trials Register (March 2002), Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2002), the National Research Register (2002), MEDLINE (from 1966 to January 2003), EMBASE (from 1980 to March 2000) and LILACS (November 2001) . We handsearched the Yearbook of Dermatology (1938-1966), the Yearbook of Drug Therapy (1949-1966), used reference lists of articles and contacted pharmaceutical companies . SELECTION CRITERIA: Randomised controlled trials of treatments for non-bullous and bullous, primary and secondary impetigo . DATA COLLECTION AND ANALYSIS: All steps in data collection were done by two independent reviewers . We performed quality assessments and data collection in two separate stages . MAIN RESULTS: We included 57 trials including 3533 participants in total which studied 20 different oral and 18 different topical treatments . CURE OR IMPROVEMENT: Topical antibiotics showed better cure rates than placebo (pooled odds ratio (OR) 6.49, 95% confidence interval (CI) 3.93 to 10.73), and no topical antibiotic was superior (pooled OR of mupirocin versus fusidic acid 1.76, 95% CI 0.69 to 2.16) . Topical mupirocin was superior to oral erythromycin (pooled OR 1.22, 95% CI 1.05 to 2.97) . In most other comparisons, topical and oral antibiotics did not show significantly different cure rates, nor did most trials comparing oral antibiotics . Penicillin was inferior to erythromycin and cloxacillin and there is little evidence that using disinfectant solutions improves impetigo . SIDE EFFECTS: The reported number of side effects was low . Oral antibiotic treatment caused more side effects, especially gastrointestinal ones, than topical treatment . REVIEWERS' CONCLUSIONS: Data on the natural course of impetigo are lacking . Placebo controlled trials are scarce . There is little evidence about the value of disinfecting measures . There is good evidence that topical mupirocin and topical fusidic acid are equally, or more effective than oral treatment for people with limited disease . It is unclear if oral antibiotics are superior to topical antibiotics for people with extensive impetigo . Fusidic acid and mupirocin are of similar efficacy . Penicillin was not as effective as most other antibiotics . Resistance patterns against antibiotics change and should be taken into account in the choice of therapy.

MMW Fortschr Med, 2003 Apr 10, 145(15), 36 - 8
{Infestation of ticks with Borrelia, and Lyme borreliosis in Germany}; Rauter C et al.; Currently, borreliosis is the most common tick-borne infectious disease in Europe and the USA . In Europe, three species of Borrelia are known to be pathogenic for humans, each of which apparently give rise to different clinical symptoms . Diagnosis is based in particular on the clinical presentation and history of exposure, and, as a rule, is confirmed by serological methods . It must, however, be remembered that the humoral immune response may appear relatively late, so at an early stage, patients are still serologically negative . Depending on the stage involved, oral or peroral antibiotic treatment is applied--however, eradication of the pathogen is unsuccessful in some cases . In future, adjuvant immunotherapy might close the therapeutic gap.

Ann Allergy Asthma Immunol, 2004 Apr, 92(4), 469 - 74
Cow's milk allergy in a patient with hyper-IgE syndrome; Hernandez-Trujillo VP et al.; BACKGROUND: Both hyper-IgE syndrome and food allergies can result in the early onset of skin rash, eosinophilia, and markedly elevated serum IgE . Occasionally, it can be difficult to distinguish the 2 disorders . Most patients with hyper-IgE syndrome do not have food allergy . OBJECTIVE: To describe a child with cow's milk allergy associated with hyper-IgE syndrome manifesting as failure to thrive (FTT) . METHODS: Epicutaneous skin prick test to cow's milk, CAP radioallergosorbent test, atopy patch tests, and double-blind, placebo-controlled milk challenge (DBPCMC) were performed . RESULTS: During initial presentation at 3 weeks of age, the circulating eosinophil count increased from 13,800/mm3 to 44,254/mm3 within 2 weeks while taking cephalexin . Despite treatment, he had worsening rash and FTT at 10 weeks of age with an IgE level of 8,454 U/mL . After changing from an infant milk formula with whey protein to an amino acid-based formula in combination with oral antibiotic treatment, his rash and growth velocity improved markedly within 2 months . IgE decreased to 2,747 U/mL . He remained clinically well for 12 months . He subsequently developed additional food and inhalant allergies with an increase in IgE to 12,150 U/mL . Cow's milk allergy was confirmed by epicutaneous skin prick test, atopy patch test, and DBPCMC . CONCLUSIONS: Traditional prophylactic antistaphylococcal antibiotics, in combination with Neocate formula, were effective in treating the early skin manifestations of hyper-IgE syndrome and FTT in this infant . Cow's milk protein allergy should be considered in patients with hyper-IgE syndrome and FTT.

Z Gerontol Geriatr, 2004 Apr, 37(2), 92 - 9
{Treatment of pressure sores in elderly patients}; Pullen R; The treatment of pressure sores in elderly patients requires careful documentation and a comprehensive treatment plan, which takes into account the patient's overall situation . The treatment has to be evidence based . At the moment only three recommendations can be based on two or more prospective, randomized clinical studies: to use a dressing to maintain a moist environment at the wound/dressing interface, to reduce the risk of infection and enhance wound healing by hand washing, wound cleansing and debridement and to institute a systemic antibiotic treatment for patients with advancing cellulitis, sepsis and osteomyelitis . For other treatment options such as topical negative pressure, maggot therapy, electromagnetic therapy, therapeutic ultrasound or growth factors, the data at present are not sufficient to support general use in pressure sore treatment.

AJR Am J Roentgenol, 2004 May, 182(5), 1159 - 65
Acute left colonic diverticulitis: can CT findings be used to predict recurrence?
Poletti PA, Platon A, Rutschmann O, Kinkel K, Nyikus V, Ghiorghiu S, Morel P, Terrier F, Becker CD.
OBJECTIVE: We explored CT and demographic predictors for unfavorable outcome of nonoperative treatment in patients with a first event of left colonic diverticulitis . MATERIALS AND METHODS: We retrospectively analyzed the medical files and CT scans of 312 consecutive patients who were diagnosed as having diverticulitis on an admission CT report or who had a final diagnosis of left colonic diverticulitis . Patients who did not undergo nonoperative treatment or were lost to follow-up (n = 144) were excluded from the study . Admission CT scans of 168 consecutive patients with a diagnosis of left colonic diverticulitis who underwent nonoperative treatment and had an 18-month follow-up were reassessed by three radiologists unaware of the clinical findings . Nonoperative treatment was defined as an attempt to treat the patient with only antibiotics without scheduling them for elective (delayed) surgery . Unfavorable outcome was defined as a failure of nonoperative treatment 18 months after admission that required either surgery or rehospitalization for antibiotic treatment . The risk of unfavorable outcome was modeled using logistic regression as a function of sex, age, and CT criteria including the maximum number of diverticula per 10 cm of colon; the presence of intraabdominal abscess or extraintestinal gas bubbles (< 5 mm diameter) or gas pockets (>or=5 mm); the length and location of the abnormal colonic segment; the maximum thickness of the colonic wall; the presence of associated free intraperitoneal fluid; and the extent of fatty infiltration . RESULTS: Among these 168 patients, 115 (68%) had an uneventful outcome, but nonoperative treatment failed in 53 (32%) . The presence of an abscess (n = 19) or extraintestinal gas pocket (n = 14) were the only CT findings significantly associated with failure of nonoperative treatment . Adjusted odds ratios (95% confidence interval) for failure were 6.18 (1.76-21.68) when an abscess was diagnosed and 4.26 (1.04-17.57) when pockets of free air were observed . Sex and age were not significantly associated with unfavorable outcome of nonoperative treatment . CONCLUSION: Abscess and pockets of extraintestinal gas 5 mm in diameter or larger correlated with unfavorable outcome of nonoperative treatment . None of the other criteria evaluated were predictive of failure of nonoperative treatment, including bubbles of extraintestinal gas smaller than 5 mm in diameter.

Intensive Care Med, 2004 Jul, 30(7), 1319 - 26 Epub 2004 Apr 20.
Blind and bronchoscopic sampling methods in suspected ventilator-associated pneumonia . A multicentre prospective study; Mentec H et al.; OBJECTIVE: To compare four sampling methods: blind tracheal aspirate (blind TA), blind protected telescoping catheter (blind PTC), bronchoscopic PTC and bronchoscopic bronchoalveolar lavage (bronchoscopic BAL), for diagnosis of ventilator-associated pneumonia (VAP) . DESIGN: Prospective multicentre study . SETTING: Five intensive care units in France . PATIENTS: Sixty-three patients with mechanical ventilation for more than 48 h, no recent antibiotic change (<72 h) and suspected nosocomial pneumonia . INTERVENTIONS: All patients underwent the four sampling methods . Direct examination and quantitative cultures of the four specimens were performed . MEASUREMENTS AND RESULTS: Visible secretions expelled from the catheter were present 40 times (63%) for blind PTC and 45 times (71%) for bronchoscopic PTC . After exclusion of 11 uncertain cases, 34 VAP were diagnosed . Direct examination of PTC (either blind or bronchoscopic) did not differ from direct examination of bronchoscopic BAL in predicting VAP diagnosis and in guiding initial antibiotic treatment correctly . Compared to that of bronchoscopic BAL (0.98), the area under receiver operating characteristics (ROC) curve was smaller for blind TA (0.78, p=0.002), blind PTC (0.83, p=0.009) and bronchoscopic PTC (0.85, p=0.01) . When samples with visible secretions expelled from the catheter were considered, blind and bronchoscopic PTC had areas under ROC curve close to that of bronchoscopic BAL (0.90, p=0.22 and 0.91, p=0.27, respectively) . CONCLUSIONS: Blind PTC appears to be a good alternative to bronchoscopic sampling for VAP diagnosis, provided that the sample contains visible secretions expelled from the catheter.

Clin Infect Dis, 2004 Apr 15, 38(8), 1102 - 7 Epub 2004 Mar 26.
Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy; Prescott WA Jr et al.; This retrospective analysis sought to determine the comparative incidence of cross-reactivity associated with carbapenem antibiotic treatment among patients with versus those without penicillin allergy . We sought to determine whether the incidence of cross-reactivity is different between imipenem-cilastatin and meropenem . A total of 211 patients were treated with a carbapenem antibiotic . Included were 100 patients with and 111 patients without a documented or reported penicillin allergy . Within each group, subgroups of penicillin-allergic and penicillin-nonallergic patients were balanced equally between imipenem-cilastatin and meropenem . The incidence of patients with a reported or documented penicillin allergy experiencing an allergic-type reaction to a carbapenem was 11%, which is 5.2 times greater than the risk in patients who were reportedly not allergic to penicillin (P=.024) . No difference in the occurrence of allergic-type reactions was observed between the 2 carbapenems.

Aust Vet J, 2004 Mar, 82(3), 154 - 6
Effect of mass medication with antibiotics at feedlot entry on the health and growth rate of cattle destined for the Australian domestic market; Cusack PM; OBJECTIVE: To examine the effectiveness of mass medication with long acting antibiotics at feedlot entry on lot-fed Australian domestic cattle during a period of high risk for bovine respiratory disease (BRD) . DESIGN: Systematic allocation at feedlot entry of tilmicosin, long acting oxytetracycline or no antibiotic treatment, to cattle lot fed for the Australian domestic market . Comparisons of growth rate, disease occurrence and mortality were made between the groups at the conclusion of the feeding period . RESULTS: Cattle medicated with tilmicosin at 10 mg/kg body weight on entry to the feedlot grew 0.08 kg/d faster than cattle medicated with oxytetracycline at 20 mg/kg body weight and non-medicated cattle . There was no significant difference in growth rate between oxytetracycline medicated cattle and cattle not medicated with antibiotic at feedlot entry . Cattle medicated with tilmicosin at feedlot entry had 8 fewer cases of disease per 100 animals compared with cattle not medicated with antibiotic at feedlot entry . There was no significant difference in disease occurrence between oxytetracycline medicated cattle and those not medicated with antibiotic at feedlot entry . CONCLUSION: Mass medication with tilmicosin at feedlot entry of cattle destined for the Australian domestic market may be used to reduce disease occurrence and increase growth rate during periods of high risk for BRD.

Hepatogastroenterology, 2004 Mar-Apr, 51(56), 541 - 6
Antibiotic prophylaxis after variceal hemorrhage reduces incidence of early rebleeding; Pohl J et al.; BACKGROUND/AIMS: This study aims to evaluate the role of new onset infection in the initiation of early rebleeding after variceal hemorrhage in patients with liver cirrhosis and the effect of prophylactic antibiotic treatment . METHODOLOGY: Two hundred and twenty-one consecutive admissions for variceal bleeding with no signs of infection at the time of admission were evaluated retrospectively . RESULTS: Systemic antibiotic prophylaxis was administered in 126 cases and significantly reduced the overall incidence of new onset infections (19.8% vs . 34.71%; p<0.01) and of early rebleeding (17.5% vs . 32.6%; p<0.01) . Multivariate analysis showed strong correlation of rebleeding with new onset infection (p<0.001) and lack of prophylactic antibiotic treatment (p<0.05) . Child-Pugh C cirrhosis, ventilatory assistance, and balloon tamponade were independent predictors of new onset infection (p<0.001, respectively) . In the subgroup of patients with at least one predictor prophylactic treatment nearly halved the incidence of infections and rebleedings while in patients without predictors it had no significant effect . CONCLUSIONS: For the first time our data indicate a role for new onset infections in initiating early rebleedings . Immediate prophylactic antibiotic treatment for patients at high risk of infection might be effective in lowering both, the risk of acquiring infections and early rebleeding.

Aust Vet J, 2003 Nov, 81(11), 688 - 93
Eradication of footrot of lesser clinical severity (intermediate footrot); Abbott KA et al.; OBJECTIVE: To determine if intermediate footrot (IFR) can be eradicated from a flock of sheep by inspection and culling of cases during a non-transmission period and if prior antibiotic treatment or vaccination increases the likelihood of eradication . PROCEDURE: A replicated field experiment that compared the three eradication strategies was followed by an observational study of the best of these applied in a commercial flock of 3000 sheep . RESULTS: In the replicated experiment, IFR was eradicated either by inspection and culling alone, or when combined with vaccination . Eradication failed when the sheep were treated with parenteral antibiotics before inspection and culling during the non-transmission period . In the whole-flock program, eradication by repeated inspection and culling of footrot cases during the non-transmission period was successful and the flock remained free of infection 3 years later . CONCLUSIONS: IFR can be eradicated by inspection and culling but latent infections, which may persist undetected for at least 34 weeks, require surveillance inspections to be repeated during the non-transmission phase of the program . The use of parenteral antibiotics as an aid to the eradication of IFR is contraindicated.

J Pediatr Gastroenterol Nutr, 2004 Apr, 38(4), 422 - 5
Helicobacter pylori eradication rate and glycemic control in young patients with type 1 diabetes; Candelli M et al.; OBJECTIVES: Eradication of Helicobacter pylori is more difficult in adult patients with diabetes than in patients with dyspepsia . It has also been suggested that eradication of H . pylori in children with type 1 diabetes mellitus improves their metabolic control . The aim of the current study was to assess the eradication rate of a standard triple therapy and its effects on glycemic control in young patients with type 1 diabetes . METHODS: The authors enrolled 29 type 1 diabetic patients with H . pylori, 29 type 1 diabetic patients without H . pylori, and 29 dyspeptic children with H . pylori . Groups were matched for gender and age and had similar geographical origin and socioeconomic status . H.pylori status was investigated before and 6 weeks after therapy by C-urea breath test . All enrolled patients with H . pylori were prescribed a standard triple therapy for eradicating H . pylori . Glycosylated hemoglobin A and daily insulin requirement were evaluated at enrollment and 6 months later in all patients with diabetes . The prevalence of the most common gastrointestinal symptoms also was investigated by means of a questionnaire in all subjects at enrollment and 6 months later . RESULTS: Eradication of H . pylori was similar in patients with diabetes (24/29) and those with dyspepsia (23/29) (83%v 79%; P = NS) . No difference in metabolic control was observed before or after antibiotic treatment in the patients who experienced H . pylori eradication . No difference in glycemic control was observed after 6 months of follow-up . CONCLUSIONS: The eradication rate of H . pylori infection was similar for young patients with type 1 diabetes and those with dyspepsia and did not improve metabolic control in a short-term follow-up.

Aust Vet J, 2003 Dec, 81(12), 742 - 4
Use of antibiotic impregnated polymethylmethacrylate beads for the treatment of chronic mandibular osteomyelitis in a Bennett's wallaby (Macropus rufogriseus rufogriseus); Hartley MP et al.; Antibiotic impregnated polymethylmethacrylate beads were surgically implanted into the mandible of an adult Bennett's wallaby (Macropus rufogriseus rufogriseus) suffering from chronic mandibular osteomyelitis that had proven refractory to systemic antibiotic treatment . Although a discrete inflammatory mass remained, clinical signs of inappetance and a discharging sinus were alleviated following implantation of the beads . This procedure resulted in a more satisfactory outcome than other methods of treatment used previously for this condition and avoided the problems associated with regular handling and prolonged medication.

Med Trop (Mars), 2003, 63(6), 608 - 10
{Bartholin gland tuberculosis: a case report in Madagascar}; Rakoto-Ratsimba HN et al.; Female genital tuberculosis is relatively frequent in developing countries . Most cases occur in young women of childbearing age . The most common locations are the tubes, endometrium, and ovaries . Bartholin gland involvement is rare . The purpose of this report is to present a case of Bartholin gland tuberculosis in a 50 year-old woman and to describe the special epidemiological, clinical and therapeutic features associated with this location . Bartholinitis develops insidiously until spontaneous fistula formation . The lesion then gradually assumes a vegetative appearance that persists despite antibiotic treatment . Diagnosis requires biopsy findings demonstrating the presence of granulomatous tissue with caseous necrosis . Patients respond favorably to specific medical treatment . The recent spread of human immunodeficiency virus has increased the need to continue and improve efforts to control turberculosis particularly in endemic zones.

Eur J Epidemiol, 2004, 19(2), 109 - 16
A diagnostic decision rule for management of children with meningeal signs; Oostenbrink R et al.; In a previous study we devised a diagnostic decision rule to improve management of children with meningeal signs, suspected of having bacterial meningitis . The decision rule aimed to guide decisions on (1) whether a lumbar puncture is necessary in children with meningeal signs, and (2) which children need hospitalisation and empirical antibiotic treatment for bacterial meningitis . In this study we assessed the validity of this rule in an external population of four (paediatric) hospitals in The Netherlands . The decision rule included two scoring algorithms using symptoms, signs and quickly available blood and cerebrospinal fluid (CSF) laboratory tests . To evaluate the discriminative value of both algorithms, the absolute numbers of correctly diagnosed patients and the area under the receiver operator characteristic curve were estimated, and compared with the results from the original population (n = 360) . In a 18 month period, we included 226 children, median age 2.2 years, who visited the emergency department with meningeal signs . Bacterial meningitis was present in 25 (11%) . Using the scoring algorithms patients could be categorised in groups of increasing risk of bacterial meningitis . The discriminative values of the clinical and CSF algorithm in this new population were similar to those in the original population . In the total population of 586 children with meningeal signs, the rule selected 205 children (35%) who did not need a lumbar puncture and 366 children who did not need empirical treatment (62%) . In conclusion, this diagnostic rule performed well in a new population of children with meningeal signs . This diagnostic decision rule is a valuable tool for the clinician when deciding to treat these children for bacterial meningitis and thus improving their management.

J Gastroenterol, 2004, 39(2), 188 - 91
Florid ischemic cholangitis due to leucocytoclastic vasculitis; Kasper HU et al.; Ischemia-induced biliary tract lesions, called ischemic cholangitis, often lead to strictures of biliary ducts and cholestasis . Causes of ischemic changes of the biliary tract can be found in the arterial blood supply or in the peribiliary capillary plexus . Known examples are thrombosis after transplantation, intraoperative ligation, or the application of chemotherapeutic drugs . Rarely, such changes are due to inflammation of the blood vessels, such as occurs in polyarteritis nodosa or giant cell arteritis . We present a report of a 49-year old man with leucocytoclastic vasculitis after viral infection, influenza vaccination, and antibiotic treatment, leading to florid ischemic cholangitis . We conclude that hypersensitivity vasculitis must be included in the differential diagnosis of cholestasis and cholangitis.

Cent Eur J Public Health, 2004 Mar, 12(1), 6 - 11
Long term and repeated electron microscopy and PCR detection of Borrelia burgdorferi sensu lato after an antibiotic treatment; Honegr K et al.; The diagnosis of Lyme disease in 18 patients has been proved by detection of Borrelia burgdorferi sensu lato when using immunoelectron microscopy or detecting its nucleic acid by PCR in the plasma or the cerebrospinal fluid . The positive results occurred in the plasma or in the cerebrospinal fluid in the period of 4-68 months after an antibiotic treatment . The typical clinical manifestations of Lyme disease were observed in 9 patients and non-specific symptoms in another 9 patients . According to presented results we can recommend repeated examination using PCR of the plasma and other biological specimens in the individuals with persistent or recurring complaints after an acute form of Lyme disease and its antibiotic treatment . Also examination of the cerebrospinal fluid with non-specific symptoms and simultaneously displayed pathology electroencephalogram and/or magnetic resonance imaging findings can be advantageous.

Br J Anaesth, 2004 Jun, 92(6), 896 - 8 Epub 2004 Apr 02.
Spinal epidural abscess--a rare complication after epidural analgesia for labour and delivery; Schroeder TH et al.; We report a case of spinal epidural abscess formation after short-term epidural catheter placement for analgesia during labour and delivery . The patient was previously healthy and did not have any predisposing factors . Increasing back pain was the only complaint . A contrast-enhanced CT study on day 5 was inconclusive . Magnetic resonance imaging was performed and showed a large triangular-shaped abscess with adjacent inflammation of the paravertebral muscles . One day later, the patient developed a sensory deficit in the left lower limb . The neurological deficit completely resolved after surgical decompression and debridement, which was followed by antibiotic treatment.

J Matern Fetal Neonatal Med, 2003 Dec, 14(6), 398 - 403
Screening and prevention of congenital toxoplasmosis: an effectiveness study in a population with a high infection rate; Ricci M et al.; OBJECTIVES: Secondary prevention of congenital toxoplasmosis has been attempted by screening pregnant women or by screening neonates . We compared the results of these two approaches, in order to evaluate the effectiveness of these strategies and of the antibiotic treatment of infected women . METHODS: A prenatal serological screening program for toxoplasmosis enrolled 8061 pregnant women; 9730 neonates were screened during the same period . RESULTS: Out of 5288 susceptible pregnancies, 188 were identified as infected by Toxoplasma gondii (35/1000) . The transmission rate was 11.3%, with a higher rate for neonates exposed in the last trimester (relative risk 10.6); four neonates were affected . Out of 9730 screened neonates, four tested positive (0.4/1000) and one was affected . Out of a total of 163 exposed neonates, 12 were clinically affected . The rate of clinical sequelae was 31.6% among those infected and 7.4% among all exposed to infection; neonates born of women who had not been treated were more likely to be affected than treated neonates (odds ratio 4), but after adjustment for trimester of infection no significant association was found . CONCLUSIONS: Neonatal screening for toxoplasmosis seems to be less effective than pregnancy screening . Observational data do not support the effectiveness of treatment during pregnancy to prevent clinical disorders.

Przegl Lek, 2003, 60(12), 832 - 5
{Extrapulmonary complications of Mycoplasma pneumoniae infections}; Wisniewska-Ligier M et al.; Mycoplasma pneumoniae is a common etiological factor in atypical pneumonia in children . The course of the disease is usually mild, but in some cases, especially in extrapulmonary localisation, it can pose significant diagnostic and therapeutic problems . The aim of this study was evaluation of extrapulmonary manifestations of Mycoplasma pneumoniae infections in children . MATERIAL AND METHODS: Among 21 children with Mycoplasma pneumoniae infection hospitalised in the III Pediatric Clinic, ICZMP in Lodz, between 2001 and 2002 three children with extrapulmonary manifestations of the disease were qualified for the study . The diagnosis was based on a test (from Biotest company) detecting specific IgM, IgG and IgA antibodies . RESULTS: In the analysed cases the manifestations of the disease were as follows: exudative gonitis (I), pain in the hip and knee joints (II) and abducens nerve paresis (III) . In I case: IgM 1/250; 1/350, IgG- > 1/1000, 1/350; IgA 1/100, negative; in II case: IgM > 1/1000, IgG > 1/1000, IgA negative . In III case IgM 1/450, 1/130; IgG > 1/1000, > 1/1000, IgA 1/300, 1/130 . In all the children there were no symptoms form the respiratory tract . In both articular forms, the disease was preceded by Borrelia burgdorferi infection localised in the same joints . Only in case of exudative gonitis an increase in the inflammatory process indexes was noticed . CONCLUSIONS: Mycoplasma pneumoniae infection should be considered also in case of extrapulmonary symptoms, with no coexisting infection in the respiratory tract . The forms of extrapulmonary manifestations, in particular concerning the joints and the nervous system, require prolonged and specific antibiotic treatment . Articular manifestation of Mycoplasma pneumoniae infection preceded by articular form of Borrelia burgdorferi infection is noteworthy, and may be caused by abnormal response form the immunological system.

Gastroenterology, 2004 Apr, 126(4), 997 - 1004
Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial; Isenmann R et al.; BACKGROUND & AIMS: Antibiotic prophylaxis in necrotizing pancreatitis remains controversial . Until now, there have been no double-blind studies dealing with this topic . METHODS: A total sample size of 200 patients was calculated to demonstrate with a power of 90% that antibiotic prophylaxis reduces the proportion of patients with infected pancreatic necrosis from 40% placebo (PLA) to 20% ciprofloxacin/metronidazole (CIP/MET) . One hundred fourteen patients with acute pancreatitis in combination with a serum C-reactive protein exceeding 150 mg/L and/or necrosis on contrast-enhanced CT scan were enrolled and received either intravenous CIP (2 x 400 mg/day) + MET (2 x 500 mg/day) or PLA . Study medication was discontinued and switched to open antibiotic treatment when infectious complications, multiple organ failure sepsis, or systemic inflammatory response syndrome (SIRS) occurred . After half of the planned sample size was recruited, an adaptive interim analysis was performed, and recruitment was stopped . RESULTS: Fifty-eight patients received CIP/MET and 56 patients PLA . Twenty-eight percent in the CIP/MET group required open antibiotic treatment vs . 46% with PLA . Twelve percent of the CIP/MET group developed infected pancreatic necrosis compared with 9% of the PLA group (P = 0.585) . Mortality was 5% in the CIP/MET and 7% in the PLA group . In 76 patients with pancreatic necrosis on contrast-enhanced CT scan, no differences in the rate of infected pancreatic necrosis, systemic complications, or mortality were observed . CONCLUSIONS: This study detected no benefit of antibiotic prophylaxis with respect to the risk of developing infected pancreatic necrosis.

Pediatr Int, 2004 Apr, 46(2), 117 - 21
How to enter the pediatric airway for bronchoscopy; Niggemann B et al.; BACKGROUND: Bronchoscopies are performed in childhood for diagnostic reasons (e.g . evaluation of stridor, unexplained cough, possible malformations) and therapeutic reasons (e.g . foreign body removal, management of the difficult airway) . METHODS: Various procedures of entering the pediatric airways are presented, based on an overview of the literature and the experience of the authors . RESULTS: The advantages and disadvantages of direct fibreoptic bronchoscopy, bronchoscopy via face mask, via laryngeal mask airway, via tracheal tube, and for combined flexible and rigid bronchoscopy are discussed . In addition, practical aspects of bronchoscopy are considered, including local anesthesia, oxygen supplementation, monitoring, antibiotic treatment . CONCLUSIONS: Although inspection of the pediatric airways has become a well-accepted routine procedure with a high diagnostic yield, and bronchoscopies are well tolerated, it is important that the most appropriate means of access to the airways is chosen according to the indications and the age of the child.

Int J Clin Pract, 2004 Feb, 58(2), 214 - 7
Subdural empyema and cerebellar abscess due to chronic otitis media; Polyzoidis KS et al.; The infratentorial variety of the subdural empyema, with or without coexisting cerebellar abscess, is a rare clinical entity that carries a high mortality rate . We briefly describe the case of a 49-year-old man presented with severe debility, fever and an obviously neglected chronic otitis media . The patient had refused surgical treatment several months ago . After admission, his level of consciousness began to deteriorate, and the radiological studies showed infratentorial subdural suppuration extending into the right cerebellar hemisphere, along with chronic pyogenic infection of the middle ear and the mastoid process . Radical mastoidectomy was performed first, followed by extensive right posterior fossa craniectomy . The two subdural collections and the cerebellar abscess were successfully evacuated . Subsequently, he received post-operative antibiotic treatment for 6 weeks . At follow-up, 10 months after surgery, his neurological recovery was complete except for a minor residual cerebellar dysfunction on the right . This unusual case highlights that in patients presented with severe intracranial complications of chronic otitis media, early diagnosis and radical surgical intervention may be life saving.

Vet Clin Pathol, 2004, 33(1), 2 - 13
Hemotrophic mycoplasmas (hemoplasmas): a review and new insights into pathogenic potential; Messick JB; The red cell parasites formerly known as Haemobartonella and Eperythrozoon spp have been reclassified as hemotrophic mycoplasmas (hemoplasmas) based on strong phylogenetic evidence and 16S ribosomal RNA gene sequences . The latter form the basis for polymerase chain reaction assays used to detect infection . Candidatus designation was given to incompletely characterized species . Like other mycoplasmas, hemoplasmas are small epicellular parasites that lack a cell wall and are susceptible to tetracyclines; their circular, double-stranded DNA encodes only those gene products essential for life . Diseases caused by infection with hemoplasmas range from overt life-threatening hemolytic anemia to subtle chronic anemia, ill-thrift, and infertility . In addition, the organisms may act as cofactors in the progression of retroviral, neoplastic, and immune-mediated diseases . Intimate contact of hemoplasma organisms with RBCs leads to cell injury through immune-mediated and other mechanisms that have not yet been defined . Despite an intense immune response and even with antibiotic treatment, infected animals probably remain chronic carriers after clinical signs have resolved.

Presse Med, 2004 Mar 13, 33(5), 303 - 9
{Treatment of functional signs of acute maxillary rhinosinusitis in adults . Efficacy and tolerance of administration of oral prednisone for 3 days}; Klossek JM et al.; OBJECTIVE: Acute maxillary rhinosinusitis (AMRS) is a pathology in which the pain is often severe and requires appropriate treatment . Although the use of antibiotics is widely documented, the interest of short cycles of corticosteroids in the treatment of the functional manifestations of AMRS is based on professional experience . The aim of this study was to assess the efficacy and tolerance to prednisone administered for 3 days in addition to antibiotherapy in patients presenting with an AMRS . METHOD: This was a double blind, randomised study in parallel groups and controlled versus a placebo, involving patients aged over 18, presenting with an AMRS confirmed by X-ray and endoscopy, having developed less than 5 days and complaining of spontaneous pain assessed as >or=50 millimetres on a visual analog scale (VAS) . Together with cefpodoxime, the patients received either prednisone (0.8 to 1.2 mg/kg) for 3 days or a placebo . The primary efficacy endpoint was the mean of the differences versus the baseline value of pain (MPID - mean pain intensity difference) assessed on the VAS from Day 1 to Day 3 . The secondary endpoints assessed were the mean of the differences in intensity of nasal obstruction, assessed in the same way as the MPID, the time lapse before the orally expressed relief of the pain (PRID - pain reflief intensity difference) and the administration of paracetamol during the first 3 days . RESULTS: 289 patients (placebo 147, prednisone 142) were assessable for analysis in intent-to-treat (ITT) . The global spontaneous pain on inclusion, measured by a VAS was of 73.0 +/- 14.1 mm . The assessments made during the first 3 days of treatment showed a statistically significant difference in favour of the prednisone group regarding MPID: - 4.82 mm (CI 95% -9.25; -0.40) (p=0.03), nasal obstruction - 5.0 mm (CI 95% -9.1; -0.8) (p=0.02) and consumption of paracetamol (p=0.03) . There was no difference between the two groups after the end of the antibiotherapy . The tolerance measured throughout the study was comparable between the two groups . CONCLUSION: This study clearly showed the efficacy of a short course of oral prednisone (3 days), versus a placebo, in the treatment of the functional signs of acute maxillary rhinosinusitis with severe pain in adults in addition to an appropriate antibiotic treatment.

Nat Rev Immunol, 2004 Feb, 4(2), 143 - 52
Elucidation of Lyme arthritis; Steere AC et al.; Before the first description of Lyme arthritis in 1976, patients with this disease were often thought to have juvenile or adult rheumatoid arthritis . It is now known that Lyme arthritis is caused by a tick-borne spirochete that disseminates to joints, where it induces marked pro-inflammatory responses . In most patients, the arthritis resolves with antibiotic treatment . However, in the United States, about 10% of patients with Lyme arthritis develop persistent synovitis, which lasts for months or even several years after the apparent eradication of the spirochete from the joint with antibiotic therapy . The elucidation of Lyme arthritis, from acute infection to chronic synovitis, might help in our understanding not only of this entity, but also of other forms of chronic inflammatory arthritis, including rheumatoid arthritis.

Arch Intern Med, 2004 Mar 22, 164(6), 637 - 44
Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia; Houck PM et al.; BACKGROUND: Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly . Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital . METHODS: We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999 . Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS) . RESULTS: Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio {AOR}, 0.85; 95% confidence interval {CI}, 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96) . Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration . Timing was not associated with readmission . Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics . CONCLUSIONS: Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients . Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.

Nervenarzt, 2004 Aug, 75(8), 734 - 41
{Neurological complications of infective endocarditis}; Angstwurm K et al.; Infective endocarditis involves the brain in 20-40% of cases . The neurologic syndrome often is the presenting feature . The most frequent neurologic complication is cerebral ischemia . In these patients and those with intracranial hemorrhage, a heart murmur as well as systemic signs of inflammation point to endocarditis . The encephalopathy in endocarditis is mostly due to cerebral infarction . In bacterial meningitis and brain abscess an uncommon isolate arouses suspicion . The most important therapy is antibiotic treatment . Valve replacement improves outcome; in the acute phase of endocarditis, however, it is only necessary in a third of the patients . Neurologic complications interfere with the timing of the valve replacement . If it is urgently required, its risk is reasonable within 3 days after cerebral ischemia; if possible 2-4 weeks should be waited . Cases of successful valve replacement within 4 weeks after intracranial hemorrhage have been reported, but it is recommended to postpone it for 4-6 weeks . There are no data available for the other neurologic complications . Even today patients with endocarditis challenge the diagnostic and therapeutic capacity of various disciplines.

Arch Mal Coeur Vaiss, 2004 Feb, 97(2), 172 - 5
{Aspergillus flavus endocarditis on a native valve}; Irles D et al.; A 33 year old female had febrile aplasia following a first chemotherapy treatment for acute T lymphoid leukaemia . She was transferred to intensive care for acute respiratory distress due to bilateral pneumonia with Stenotrophomonas maltophilia septicaemic shock . After an initial improvement with antibiotic treatment, she developed multiple necrotic cutaneous lesions . A skin biopsy showed the presence of Aspergillus flavus in large quantities in the vascular lumina . Echocardiography revealed a voluminous vegetation on the mitral valve supporting aspergillus endocarditis . Despite antifungal treatment, shock and coma developed rapidly . Cerebral CT scan suggested multiple septic emboli . Within several hours, the scenario progressed towards multiorgan failure leading the death of the patient . Aspergillus endocarditis is exceptional and usually only occurs in immunosuppressed patients . The diagnosis is difficult, and the prognosis is appalling with a mortality greater than 90% despite treatment.

No Shinkei Geka, 2004 Feb, 32(2), 143 - 9
{Antibiotic treatment for traumatic brain injury patients without positive bacterial cultures}; Nagashima G et al.; Prophylactic administration of antibiotics is prevalent for traumatic patients including head injury, when the patients have contaminated wounds, CSF leakage, and multiple injuries . In cases with prolonged fever and inflammatory signs, other antibiotics must be selected without confirming the infections by cultures . Usually, 1st or 2nd generation cefalosporins are selected as empiric therapy for traumatic patients, but, successive antibiotics are usually selected according to the situation . In this study, we analyzed 60 cases of head injured patients with Glasgow Coma Scale under 12, in terms of the selection of antibiotics and the reasons for the antibiotic selections . CEZ > PIPC > FMOX were used for initial treatment without any culture results . The second selection was made without any positive culture results in 85.7%, and tertiary selection without culture results in 50% of the patients . CPR > CFSL > FMOX > PAPM/BP were mainly used as second selection, and IPM/CS > CPR = PIPC were mainly used as tertiary selection . In cases with traumatic brain injuries, it is important to prevent antibiotic resistances . 1) by selecting appropriate antibiotics, 2) by using antibiotics after excluding catheter related infections, 3) by not using antibiotics and performing frequent cultures when no apparent infection focuses are detected.

J Am Podiatr Med Assoc, 2004 Mar-Apr, 94(2), 157 - 67
Pulmonary disease: pneumonia, chronic obstructive pulmonary disease, asthma, and thromboembolic disease; de Palo VA; Although many medical problems are generally managed in concert with a general medical physician, it is important for the podiatric physician to be familiar with some of the major diseases of the lung . Pneumonia, an infectious process within the lung, is the sixth-leading overall cause of death . Antibiotic treatment, oxygen administration, and supportive care are the mainstays of its therapy . Chronic obstructive pulmonary disease presents as a spectrum from chronic bronchitis, with a greater inflammatory component, to emphysema, with a more significant destructive component . Asthma, often a more episodic chronic obstructive disease, is characterized by inflammation of the airways leading to their narrowing . The work of breathing is often increased in these diseases, and treatment is with combination therapies with a focus on smoking cessation . Thromboembolic disease, the occlusion of blood vessels with consequent interruption of blood flow, may occur in a patient with risk factors, especially after surgery . Treatment is with anticoagulation agents or in some cases with thrombolysis . Prophylaxis is key.

Rinsho Byori, 2004 Feb, 52(2), 120 - 3
{A case of pseudothrombocytopenia during antibiotic administration}; Kinoshita Y et al.; A 70 year-old woman was prescribed of levofloxacin and ceftriaxone for acute bronchitis . On the seventh day of administration she was hospitalized with a dry cough and a decreased platelet count(2.1 x 10(4)/microliter) . However, bleeding tendency was not seen . So, we changed anticoagulants with citric acid and heparin from EDTA, and measured platelet count because we suspected pseudothrombocytopenia(PTCP), then platelet count became elevated (respectively, 12.5 x 10(4)/microliter and 15.0 x 10(4)/microliter) . In addition, platelet associated IgG increased to 309.3 ng/10(7) cells . Based on drug lymphocyte stimulation test, she was diagnosed as having antibiotic-induced PTCP, especially as she had no history of thrombocytopenia . PTCP should be considered when thrombocytopenia occurs during antibiotic treatment.

Dent Traumatol, 2004 Apr, 20(2), 75 - 84
Pulp revascularization of replanted immature dog teeth after treatment with minocycline and doxycycline assessed by laser Doppler flowmetry, radiography, and histology; Ritter AL et al.; This study investigated the effect of topical antibiotic treatment on pulp revascularization in replanted teeth . Thirty-four immature teeth were selected from three young dogs . Baseline radiographs and laser Doppler flowmetry (LDF) readings were obtained . Specimens were randomly divided into four groups: Thirty-eight teeth were extracted, kept dry for 5 min, and either (Group 1) covered with minocycline mixture (G1, n = 11), (Group 2) soaked in doxycycline (G2, n = 11), or (Group 3) soaked in saline (G3-negative control, n = 6), and replanted . Teeth in Group 4 were not extracted (positive control, n = 6) . Postoperative radiographs and LDF readings were obtained for 2 months after replantation . After sacrifice, the jaws were collected and processed for light microscopy . Pre- and postreplantation LDF readings and radiographs, and histologic findings were analyzed to assess revascularization . Pulp revascularization occurred in 91% (G1), 73% (G2), and 33% (G3) of the specimens . In conclusion, minocycline facilitates pulp revascularization in replanted immature teeth after replantation . Copyright Blackwell Munksgaard, 2004.

Infect Dis Obstet Gynecol, 2003, 11(3), 157 - 60
Relationship of fungal vaginitis therapy to prior antibiotic exposure; Glover DD et al.; OBJECTIVE: To address the putative association of antibiotic use and subsequent yeast vaginitis in a population of non-pregnant women . METHODS: Three hundred and sixteen women who received medical care in rural family medicine clinics enrolled in this study . Participants were pre-menopausal and non-pregnant and were followed until they used a course of antifungal therapy for vaginitis, became pregnant or moved from the catchment area . At entry subjects were free of vaginitis symptoms and had taken no antibiotics for 30 days . Patients were followed by repeated review of clinic records, hospital records and telephone or personal interviews . Data collection included documentation of episodes of antifungal treatment for vulvovaginal candidiasis and confirmed antibiotic treatment or credible history of antibiotic use prior to the use of antifungal therapy . Physician-reported uses of antibiotic and antifungal as well as patient-reported uses of these were recorded . RESULTS: There were four reported cases of antifungal therapy following within a month of antibiotic use, in contrast to 484 antibiotic uses not followed by antifungal use . If time of observation was extended to 6 months from antibiotic use, there were 13 uses of antifungal therapy after antibiotics and 475 uses of antibiotics not followed by antifungal therapy . CONCLUSION: Our results cast doubt on the association of antibiotics as a putative cause of yeast vulvovaginitis.

J Urol, 2004 Apr, 171(4), 1611 - 4
Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants; Carson CC 3rd; PURPOSE: We compared infection rates in original inflatable penile prostheses implants between prostheses impregnated with InhibiZone (American Medical Systems, Minnetonka, Minnesota), an antibiotic surface treatment, and prostheses without antibiotic treatment . MATERIALS AND METHODS: We retrospectively reviewed patient information forms filed with the manufacturer following original implantation in the United States to implant AMS 700 series penile prostheses (American Medical Systems) between May 1, 2001 and April 30, 2003 . We compared results in 4205 men, including 2261 with a mean age of 60.71 years who received prostheses with InhibiZone, a surface treatment combining rifampin and minocycline hydrochloride, and a control group of 1944 with a mean age of 61.04 years who received untreated prostheses . Followup in the treatment and control groups was 0 to 11.5 months (mean 5 and 8, respectively) . In the treatment group only implants in which all components were treated were included . RESULTS: The reported incidence of infection after 60 days was 0.28% in the treated group and 1.59% in the control group (p = 0.0034) . After 180 days the infection rate in the treated and control groups was 0.68% and 1.61%, respectively (p = 0.0047) . The treated group had an infection rate that was 82.4% lower than in the control group after 60 days and 57.8% lower after 180 days . Erectile dysfunction etiologies occurred at statistically similar rates in the 2 groups and did not impact infection rate results . CONCLUSIONS: The use of InhibiZone to target postoperative infections results in a statistically significant decrease in penile prosthesis infection rates in original implants . Infection rates in the control group were consistent with those in the published literature.

Clin Gastroenterol Hepatol, 2004 Feb, 2(2), 135 - 8
Enteroaggregative Escherichia coli diarrhea in travelers: response to rifaximin therapy; Infante RM et al.; BACKGROUND AND AIMS: We have recently shown that enteroaggregative Escherichia coli (EAEC) strains commonly cause travelers' diarrhea . The study was designed to determine whether U.S . travelers with EAEC diarrhea responded to rifaximin therapy . METHODS: In a multicenter placebo-controlled clinical trial of travelers' diarrhea without non-EAEC pathogens we evaluated 2 doses of rifaximin . EAEC was sought in stool samples in enrolled subjects by HEp-2 cell assay . Response to rifaximin (both groups combined) and placebo were evaluated in EAEC-positive and EAEC-negative patient groups . RESULTS: Compared with placebo, rifaximin shortened the postenrollment illness in travelers with EAEC diarrhea (median, 22 vs . 72 hours; P = 0.03) . In subjects with EAEC-negative diarrhea, the median duration of post-treatment diarrhea was shorter with rifaximin (33 hours) than with placebo (52 hours), but this difference was not significantly different (P = 0.14) . CONCLUSIONS: Improvement of EAEC-mediated diarrhea with antibiotic treatment supports the pathogenicity of this organism in travelers to developing countries . The study provides information on the value of the poorly absorbed drug rifaximin in therapy of travelers' diarrhea.

Fundam Clin Pharmacol, 2003 Dec, 17(6), 725 - 9
Prescribing antibiotics in odontology and stomatology . Recommendations by the French Health Products Safety Agency; French Health Products Safety Agency (Afssaps); In order to limit the onset of adverse effects and the increasing emergence of bacterial resistance, the prescription of antibiotics must be reserved strictly for situations where their efficacy has been demonstrated . The French Health Products Safety Agency (Afssaps) has updated recommendations concerning the use of antibiotic treatment in odontology and stomatology . The general strategy for the prescription of antibiotics proposed by the present recommendations relies on a professional consensus . The full-length, discussed and referenced text is available at the web site of Afssaps in the 'Documentation et publications' rubric'.

Int J Antimicrob Agents, 2004 Feb, 23(2), 138 - 43
Telephonic back-up improves antibiotic compliance in acute tonsillitis/pharyngitis; Urien AM et al.; A randomised clinical trial was devised to establish whether telephonic back-up added to educational strategy and improved compliance with antibiotic treatment in acute tonsillitis/pharyngitis compared with educational strategy only . The intervention group was given a telephone call on the fourth day after the start of therapy . There were 64 patients in each group (intervention and control) . The criterion for evaluating the compliance was to count the tablets in a spot-check at the patient's house . A tablet count of 80-110% defined good compliance . The effect of the intervention was calculated according to the indicators: absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT) . A good compliance percentage was 66.1% (57.7-74.5%) and was significantly higher in the intervention group (78.3%) than in the control group (54.1%) ( P=0.005) . Indicators of clinical relevance after the intervention were ARR: 24.2%; RRR: 52.7%; NNT: 4.13 . In conclusion telephonic back-up significantly improved the compliance obtained by educational strategy only . It should be used in clinical practice.

Biomed Environ Sci, 2003 Dec, 16(4), 340 - 7
Effect of antibiotic treatment on toxin production by Alexandrium tamarense; Wang CH et al.; OBJECTIVE: Impact of the presence of bacteria associated with a marine dinoflagellate, Alexandrium tamarense CI01, on the growth and toxin production of the algae in batch culture was investigated . METHODS: Pronounced changes in the activities of the algal culture were observed when the culture was treated with different doses of a mixture of penicillin and streptomycin . RESULTS: In the presence of antibiotics at the initial concentration of 100 u/mL in culture medium, both algal growth and toxin yield increased markedly . When the concentration of antibiotics was increased to 500 u/mL, the microalgal growth was inhibited, but resumed in a few days to eventually reach the same level of growth and toxin production as at the lower dose of the antibiotics . When the antibiotics were present at a concentration of 1 000 u/mL, the algal growth was inhibited permanently . CONCLUSIONS: The results indicate that antibiotics can enhance algal growth and toxin production not only through their inhibition of the growth and hence competition for nutrients, but also through their effects on the physiology of the algae.

Rheumatol Int, 2005 Jan, 25(1), 69 - 71 Epub 2004 Mar 6.
A case of brucellar septic arthritis of the knee with a prolonged clinical course; Ayaslioglu E et al.; Brucellosis is a systemic infectious disease with a broad spectrum of clinical manifestations . Arthritis is frequently observed in its course and may be one of the main presenting clinical features of the disease . We report a case of brucellar monoarthritis of the knee with a prolonged clinical course despite efficient antibiotic treatment.

HNO, 2004 Mar, 52(3), 251 - 4
{Lemierre syndrome: thrombosis of the internal jugular vein after tonsillectomy}; Sagowski C et al.; BACKGROUND: Thrombosis of the internal jugular vein is a rare and critical disease which can also be a complication of a benign oropharyngeal infection (Lemierre syndrome) . PATIENT: A 62 year old patient underwent septomplasty, endonasal turbinectomy, paranasal sinus surgery and tonsillectomy . The postoperative course was uneventful until the 11th post operative day when the patient reported a painful swelling on the right side of the neck . Color Doppler ultrasonography demonstrated thrombosis of the right internal jugular vein and a CT-scan showed a right sided cervical phlegmonous soft tissue inflammation originating from the right oropharynx . Despite immediate intravenous antibiotic treatment, the patient developed a septic infection and resection of the jugular vein was conducted . CONCLUSION: Lemierre syndrome is a rare condition which may also follow tonsillectomy . Under septic conditions, the resection of the internal jugular vein has to be performed to avoid serious complications.

Graefes Arch Clin Exp Ophthalmol, 2004 Jul, 242(7), 614 - 6 Epub 2004 Mar 02.
Interaction of indomethacin and ciprofloxacin in the cornea following phototherapeutic keratectomy; Szentmary N et al.; BACKGROUND: We report a case in which stromal deposits were produced due to drug interaction in a 61-year-old patient following phototherapeutic keratectomy (PTK) . METHODS: In our case, the patient herself added the use of indomethacin eye drops to the prescribed topical antibiotic treatment and eye gel (5x ciprofloxacin plus 3x indomethacin, eye gel overnight) following PTK . At 5 days the central stroma was not reepithelialised; instead, whitish, round deposits were found in the stroma . Mixing indomethacin and ciprofloxacin eye drops 1:1, the pH of the mixture changed to 5.6, and a yellow precipitate was formed; this was analysed by (1)H-NMR spectroscopy . To investigate the solubility of the two drugs at the pH of the mixture, the pH of each solution was independently set to 5.6 by addition of hydrochloric acid or sodium hydroxide . RESULTS: In the precipitate both indomethacin and ciprofloxacin were detected . After setting the pH to 5.6, a yellow precipitate was observed in the indomethacin solution; however, the ciprofloxacin solution remained clear . CONCLUSIONS: Interaction may occur if ciprofloxacin and indomethacin are used together . It is better to avoid the use of the two drugs at the same time, particularly in the case of a large epithelial defect when stromal deposition of the drugs may be produced.

Minerva Anestesiol, 2004 Mar, 70(3), 125 - 9
Multiple treatment of gas gangrene at a rare anatomic location . Case report; Rossitto M et al.; The authors report a clinical case of gas gangrene in a rare anatomic location in a 79-year-old woman, admitted because 3 days earlier she had developed a painful swelling with erythematous cutis in her right iliac fossa and suffered from a seriously increasing fever . The physical examination showed a large area of gas gangrene . In accordance with international literature, excellent results have been obtained by adopting an early multiple therapy (including surgical debridement, intensive therapy, antibiotic treatment and hyperbaric oxygen treatment).

J Matern Fetal Neonatal Med, 2003 Nov, 14(5), 344 - 8
Maternal rehospitalization after singleton term vaginal delivery; Bashiri A et al.; OBJECTIVE: To determine risk factors for maternal rehospitalization after term vaginal delivery . STUDY DESIGN: The study group consisted of all women who were rehospitalized following singleton vaginal deliveries during 1996-1998 (n = 194) . The control group consisted of 427 women who were not rehospitalized during the same period . RESULTS: The incidence of rehospitalization was 0.75% (194/25885) . Maternal chronic diseases, preterm contractions and pre-eclampsia rates were significantly higher among the study group as compared to the controls (25.3% vs . 8.4%, p < 0.001; 6.7% vs . 2.8%, p = 0.022; 9.3% vs . 4.9%, p = 0.037, respectively) . Duration of labor was significantly longer in the study group as opposed to the controls (379 +/- 406 min vs . 259 +/- 276 min, p < 0.001) . The rates of postpartum hemorrhage, blood transfusion and antibiotic treatment during delivery hospitalization were significantly higher among the study group (1.5% vs . 0.2%, p = 0.021; 4.6% vs . 0.7%, p < 0.001; 26.8% vs . 14.1%, p < 0.001, respectively) . Using a forward logistic regression analysis, prolonged labor and blood transfusion during labor were found as independent risk factors associated with rehospitalization (OR 1.001, 95% CI 1.001-1.002, p = 0.001; OR 4.751, 95% CI 1.698-13.292, p = 0.003) . In contrast, vertex presentation had a protective effect against rehospitalization (p = 0.027, OR 0.084, 95% CI 0.009-0.758) . CONCLUSIONS: Blood transfusion and prolonged labor are independent risk factors for rehospitalization after term vaginal delivery . Special attention should be given during the early postpartum period to patients receiving blood transfusions and those with prolonged deliveries, in order to reduce rehospitalization rates.

Thorax, 2004 Mar, 59(3), 242 - 6
Long term clinical outcome of home and hospital intravenous antibiotic treatment in adults with cystic fibrosis; Thornton J et al.; BACKGROUND: Several studies have suggested that clinical outcomes in adults with cystic fibrosis (CF) are equivalent after home and hospital treatment with intravenous antibiotics, but these studies were small and selective and only considered one course of treatment . METHODS: A retrospective longitudinal study was performed to compare the clinical outcome over a period of 1 year of all patients attending the Manchester Adult CF Unit who received intravenous antibiotics at home or in hospital . The primary outcome measure was percentage change in forced expiratory volume in 1 second (FEV(1)) at the end of the 1 year period . Baseline "best" and "average" FEV(1) values were established for each patient for the year before the study . The secondary outcome measures were percentage changes in forced vital capacity (FVC) and body weight . RESULTS: A total of 116 patients received 454 courses of intravenous antibiotics . At the end of 1 year there had been a mean percentage decline in FEV(1) compared with the baseline "average" for patients treated mostly at home but an improvement in patients treated mostly in hospital (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p = 0.003) . For all patients there was a mean percentage decline in FEV(1) from the baseline "best" value . For each course of treatment the mean percentage improvements in FEV(1) at the end of the course from the start of the course were significantly higher for patients treated in hospital than for those treated at home . CONCLUSIONS: Clinical outcome, as defined by spirometric parameters and body weight, was better after a course of treatment in hospital than after home treatment, and this benefit was maintained over 1 year of treatment . The results suggest that patients treated at home need closer supervision.

Thorax, 2004 Mar, 59(3), 231 - 6
Neutrophil apoptosis, proinflammatory mediators and cell counts in bronchiectasis; Watt AP et al.; BACKGROUND: Lower airway secretions from patients with bronchiectasis show inflammatory cell infiltration and increased proinflammatory mediators . The aim of this study was to investigate the effects of antibiotic treatment for exacerbations on neutrophil apoptosis and necrosis . METHODS: Sputum was induced from 15 subjects with idiopathic bronchiectasis at the beginning of an acute exacerbation and after intravenous antibiotic treatment . Neutrophil apoptosis and necrosis were assessed using flow cytometry and morphology and the supernatant was analysed for concentrations of inflammatory mediators . RESULTS: Neutrophil numbers (x10(6) cells/g sputum) in sputum were significantly greater on day 0 than on day 14 (median difference (95% confidence interval (CI)) 5.14 (1.27 to 8.46), p = 0.02) . Controls had a significantly higher percentage of sputum macrophages than patients with bronchiectasis (day 0, 1.35 (95% CI 0.48 to 2.89), p = 0.004; day 14, 1.09 (95% CI 0.26 to 2.86), p = 0.02) . The concentrations of tumour necrosis factor alpha (pg/ml), interleukin 8 (ng/ml), and neutrophil elastase (ng/ml) in sputum supernatant were significantly reduced on day 14 compared with day 0 (median difference -94 (95% CI -158 to -27), p = 0.005; -106 (95% CI -189 to -50), p = 0.0006; and -73 451 (95% CI -135 495 to -12 303), p = 0.02 respectively) . Patients with bronchiectasis had a significantly lower percentage of cells which were neither apoptotic nor necrotic than healthy controls (both days, -38.8 (95% CI -49.6 to -8.5), p = 0.002; -45.0 (95% CI -58.0 to -34.1), p = 0.0003, respectively), and on day 14 they had a significantly higher percentage of secondary necrotic cells than healthy controls (40 (95% CI 11.6 to 57.5), p = 0.004) . CONCLUSIONS: This study shows that antibiotic treatment affects concentrations of proinflammatory mediators and cell death and clearance may be altered in bronchiectasis.

Ann Pharmacother, 2004 Apr, 38(4), 606 - 8 Epub 2004 Feb 24.
Reversible coma secondary to cefepime neurotoxicity; Abanades S et al.; OBJECTIVE: To describe a case of cefepime neurotoxicity associated with acute renal failure that resulted in nonconvulsive status epilepticus . CASE SUMMARY: A 66-year-old woman with acute myeloid leukemia had fever on the third day of the initial chemotherapy cycle . Empiric antibiotic treatment with cefepime 2 g every 8 hours was started; fluconazole and vancomycin were subsequently added due to the persistence of fever . Ten days after initiation of cefepime, the patient developed acute renal failure followed by altered consciousness (Glasgow coma scale 6) associated with nonconvulsive status epilepticus . Cefepime was discontinued . Epileptiform activity in the electroencephalogram disappeared with clonazepam, and the patient regained consciousness 48 hours after cefepime withdrawal . DISCUSSION: Acute renal impairment combined with the use of cefepime may account for nonconvulsive status epilepticus . An objective causality assessment revealed that the adverse event was probably due to cefepime . Cefepime's neurotoxic effects derive from high serum concentrations resulting from decreased renal clearance, increased unbound antibiotic, and blood-brain barrier dysfunction during uremia . CONCLUSIONS: The combination of cefepime treatment and acute renal failure may induce drug-related neurotoxicity . Nonconvulsive status epilepticus frequently passes unnoticed in severely ill patients without a history of epilepsy . This disorder should be included in the list of potential causes of coma . In this patient, early detection of nonconvulsive status epilepticus and withdrawal of the antibiotic resulted in full recovery.

Cochrane Database Syst Rev . 2004;(1):CD003767.
Antibiotics for ureaplasma in the vagina in pregnancy; Raynes-Greenow CH et al.; BACKGROUND: Preterm birth is a significant obstetric problem in high-income countries . Genital infection including ureaplasmas are suspected of playing a role in preterm birth and preterm rupture of the membranes . Antibiotics are used to treat women with preterm prelabour rupture of the membranes and results in prolongation of pregnancy and lowers the risks of maternal and neonatal infection . However, antibiotics may be beneficial earlier in pregnancy to eradicate potentially causative agents . OBJECTIVES: The objective of this review is to assess whether antibiotic treatment of pregnant women with ureaplasma in the vagina reduces the incidence of preterm birth and other adverse pregnancy outcomes . SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (April 2003) . SELECTION CRITERIA: All randomised controlled trials that compared any antibiotic regimen with placebo or no treatment in pregnant women with ureaplasma detected in the vagina . DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed eligibility and trial quality and extracted data . MAIN RESULTS: One trial involving 1071 women was included . Of these, 644 randomly received antibiotic treatment (174 erythromycin estolate, 224 erythromycin sterate, and 246 clindamycin hydrochloride) and 427 received placebo . This trial did not report data on preterm birth . Incidence of low birthweight less than 2500 grams was only evaluated for erythromycin (combined) (n = 398 ) compared to placebo (n = 427) and there was no statistically significant difference between those treated and those not treated (relative risk (RR) 0.70, 95% confidence interval (CI) 0.46 to 1.07) . In regards to side-effects sufficient to stop treatment, data were available for all women, and there were no statistically significant differences between any antibiotic (combined) and the placebo group (RR 1.25, 95% CI 0.85 to 1.85) . REVIEWER'S CONCLUSIONS: There is insufficient evidence to show whether giving antibiotics to women with ureaplasma in the vagina will prevent preterm birth.

Am J Cardiol, 2004 Feb 15, 93(4), 513 - 5
Analysis of infective endarteritis in patent ductus arteriosus; Sadiq M et al.; This study reports on infective endarteritis in 14 children with patent ductus arteriosus over a period of 6 years . Infective endarteritis mostly involved the small ducts and was previously undiagnosed . These patients were given antibiotic treatment for a variable period of 4 to 10 weeks, and all except 1 underwent subsequent closure.

Intern Med, 2004 Jan, 43(1), 49 - 54
Improvement of chronic nonspecific symptoms by long-term minocycline treatment in Japanese patients with Coxiella burnetii infection considered to have post-Q fever fatigue syndrome; Arashima Y et al.; OBJECTIVE: To address the presence of post-Q fever fatigue syndrome (post-QFS) in Japan, and to evaluate the efficacy of minocycline for this condition . PATIENTS AND METHODS: In 20 Coxiella burnetii (C . burnetii) seropositive patients with persistent nonspecific symptoms including general fatigue, low-grade fever, myalgia and arthralgia, changes in subjective symptoms, C . burnetii antibody titers and C . burnetii DNA were evaluated after antibiotic treatment . RESULTS: After treatment mainly with minocycline (100 mg/day for 3 months), the clinical picture improved in all 20 patients as evidenced by decreases in body temperature (13/17), general fatigue (20/20) and headache (9/12) . The mean performance status (PS) score improved from 5.0 to 1.8 (p<0.01) . All 7 who had been positive for C . burnetii DNA, became negative together with an improvement in subjective symptoms . Indirect immunofluorescence tests demonstrated 6 of the 20 patients to be positive for C . burnetii IgM antibody to phase II antigen (1:32), and 18 to be positive for IgG antibody (1:128, 1:256) . Antibody titers of both IgM (6/6, 1:16) and IgG (18/18, 1:16) decreased markedly after treatment . CONCLUSION: These results of an open label study in Japan suggest that minocycline administration is useful for improving chronic nonspecific symptoms considered to be post-Q fever fatigue syndrome caused by C . burnetii infection.

Ned Tijdschr Geneeskd, 2004 Jan 17, 148(3), 113 - 7
{An unsuspected imported disease: meningo-encephalitis contracted in Spain}; Thijssen HS et al.; A 13-year-old boy consulted a doctor during a holiday in Spain because of high fever, headache and exanthema . A local physician prescribed josamycin, but the medication was lost due to vomiting . A few days later, shortly after returning to the Netherlands, he was hospitalised with a life-threatening neurologic and multi-organ failure . It took two weeks before the diagnosis 'Mediterranean spotted fever' was made and an appropriate antibiotic treatment was started . The patient made a slow but successful recovery . Rereading the hand-written Spanish medical report revealed that it had mentioned a correct diagnosis and adequate treatment . An apparently safe holiday destination thus does not exclude an imported disease . Knowledge of local epidemiology and good communication with the locally consulted medical system are essential for a correct diagnosis and therefore for appropriate treatment and a good prognosis.

Respir Med, 2004 Jan, 98(1), 17 - 24
Community-acquired pneumonia mortality: a potential link to antibiotic prescribing trends in general practice; Price DB et al.; BACKGROUND: Community prescribing of antibiotics has decreased substantially in the UK in recent years . We examine the association between pneumonia mortality and recent changes in community-based antibiotic prescribing for lower respiratory tract infections (LRTI) . METHODS: Retrospective analysis of aggregated data for pneumonia mortality, influenza incidence, and antibiotic prescribing for LRTI in England and Wales during 12-week winter periods between 1993/94 and 1999/2000 . RESULTS: Winter antibiotic prescribing for LRTI showed a 30.0% decline since 1995/96 . Over the same period, there was a 50.6% increase in winter excess pneumonia mortality adjusted for influenza incidence . Negative binomial regression analysis showed that the incidence of influenza alone had a significant association with winter pneumonia mortality (P<0.001) . The analysis also showed the reduction in antibiotic prescribing had a small but significant association with mortality (P<0.001), when simultaneously modelling for influenza incidence . CONCLUSIONS: Our findings suggest an association between recent reductions in antibiotic prescribing for LRTI in general practice and an increase in pneumonia mortality in England and Wales . This retrospective study of aggregate data represents the first attempt to assess the effect of limiting antibiotic prescribing on patient outcomes, and highlights the need to identify which patients benefit from antibiotic treatment for LRTI.

Chirurgia (Bucur), 2000 Nov-Dec, 95(6), 511 - 21
{Pyogenic liver abscess}; Grigoroiu M et al.; The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA) . Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital . The incidence of cryptogenic abscesses was dominant (55.5%) . The symptoms and the biological status are frequently nonspecific . The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3% . The aerobe germs are most involved . All patients received antibiotic treatment in preoperative as in postoperative period . The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed . Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%) . The clinical evolution was good in 21 patients (77.7%) . There was four complications (14.8%) and two death (7.4%) . Although with a better prognostic, the PLA remains an important pathology.

Nervenarzt, 2004 Feb, 75(2), 145 - 8
{Atypical encephalitis in a 20-year-old soldier}; Lanczik O et al.; We report a patient with encephalitis who had been diagnosed with an unspecific aetiology . During follow-up, pneumonia was identified due to Mycoplasma pneumoniae infection that could also be confirmed as causal for the brain inflammation . Despite the initially critical clinical situation, the patient's condition improved under specific antibiotic treatment . Pathophysiologic, differential diagnostic, and therapeutic implications are discussed, and guidelines for diagnosis are proposed.

Circulation, 2004 Mar 2, 109(8), 1010 - 5 Epub 2004 Feb 09.
Progression of early carotid atherosclerosis is only temporarily reduced after antibiotic treatment of Chlamydia pneumoniae seropositivity; Sander D et al.; BACKGROUND: Chlamydia pneumoniae (Cp) infection has been associated with atherosclerosis and cardiovascular events . There are controversial results regarding the beneficial effects of antibiotic therapy on future cardiovascular end points . METHODS AND RESULTS: We determined the long-term effect of a 30-day roxithromycin therapy on intima-to-media thickness (IMT) progression of the common carotid artery in 272 consecutive Cp-positive and Cp-negative patients with ischemic stroke in a prospective, double-blind, randomized trial with a follow-up of 4 years . Cp IgG (> or =1:64) or IgA (> or =1:16) antibodies were initially found in 125 (46%) patients . During the 3 years before antibiotic therapy, Cp-positive patients showed an enhanced IMT progression even after adjustment for other cardiovascular risk factors (0.12 {0.11 to 0.14} versus 0.07 {0.05 to 0.09} mm/year; P<0.005) . The 62 Cp-positive patients given roxithromycin showed a reduced IMT progression during the first 2 years compared with the Cp-positive patients without therapy (0.07 {0.045 to 0.095} versus 0.11 {0.088 to 0.132} mm/year; P<0.01) . However, IMT progression increased again during the third and fourth year to similar values as before treatment . No significant difference in the occurrence of future cardiovascular events was found between both groups during follow-up . CONCLUSIONS: The only limited positive impact of antibiotic therapy on early atherosclerosis progression in Cp-positive patients observed in our study may explain the negative results of most antibiotic trials on clinical end points.

Turk J Pediatr, 2003 Oct-Dec, 45(4), 311 - 4
C-reactive protein: a sensitive marker in the management of treatment response in parapneumonic empyema of children; Dilber E et al.; C-reactive protein (CRP) is one of the best indicators of the acute phase response to inflammation . The rapid kinetics of CRP metabolism appears to closely parallel the degree of inflammation . The purpose of this prospective study was to analyze the clinical value of CRP, erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) in the assessment response to treatment in children with parapneumonic empyema . Thirty-eight children were prospectively studied . CRP was elevated in all patients on the day of hospital admission . With antibiotic treatment, serum CRP levels fell rapidly within the first days, and in 32 patients who had uncomplicated course, serial CRP levels fell progressively at each measurement . All but four patients had normal CRP levels on the day of hospital discharge . ESR was also elevated in all patients on the day of hospital admission . Despite antibiotic treatment, ESR continued to increase in all patients in the first few days, with peak values reached on day 3 . Only three patients had normal ESR levels on the day of hospital discharge . In six patients who had a complicated course, after an initial decrease, CRP levels began to rise earlier than ESR and WBC count . Plasma CRP level is a sensitive marker not only in the diagnosis of parapneumonic empyema, but also in the management of treatment response.

Arch Orthop Trauma Surg, 2004 Apr, 124(3), 161 - 5 Epub 2004 Feb 06.
Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation; Andreassen GS et al.; INTRODUCTION: Sufficiently stable constructs may be difficult to obtain with ankle fractures in patients with severe osteopenic bone . Augmentation of the osteosynthesis with a new synthetic bone void filler may help to solve this problem, and it can improve the clinical outcome . MATERIALS AND METHODS: A prospective, open-label study was performed in two surgical clinics in Norway . In 37 of 42 selected patients with Weber type B ankle fractures showing clinical and radiologic signs of osteopenic bone, at least one screw was found to be stripping during open reduction and internal fixation (ORIF) . All the stripped screws were augmented with the bone void filler, and tightness was assessed clinically afterwards . All patients were followed up for 2 years . Successful healing of the fracture after 3 months and absence of radiographic movement of the augmented screws were assessed relative to the plate and the bone . Safety was assessed by recording adverse events and abnormal haematology findings . RESULTS: All 86 augmented screws were clinically tight after augmentation . After 3 months, all fractures healed, and 1 augmented and 1 non-augmented screw appeared to be radiographically loose . After 2 and 6 months, respectively, deep wound infections occurred in 2 patients (5%), necessitating antibiotic treatment, revision surgery and implant removal . After 2 years, all patients had resumed their normal daily activities, and none of the augmented screws showed signs of loosening . CONCLUSIONS: Augmentation of bone screws with this new synthetic bone void filler was an effective means of gaining screw anchorage . Screw stabilisation with the new synthetic bone void filler proved to be safe and effective in the ORIF of ankle fractures in patients with osteopenic bone.

J Pediatr Hematol Oncol, 2004 Feb, 26(2), 108 - 11
Herpes simplex virus pneumonia in a patient with ependymoma; Inaba H et al.; The authors report a fatal outcome in a 4-year-old boy with herpes simplex virus (HSV) pneumonia and ependymoma . The patient had respiratory distress that worsened despite antibiotic treatment . Bronchoalveolar lavage showed intranuclear viral inclusions, and culture was positive for HSV type 1 . His T-cell count was significantly decreased . Although acyclovir and foscarnet were given, the patient died . Postmortem examination showed HSV pneumonitis with severe alveolar damage and severe involutional changes of the thymus with absence of Hassall's corpuscles . HSV must be considered in the differential diagnosis of patients with interstitial pneumonia and T-cell deficiency, especially after craniospinal irradiation.

Fetal Diagn Ther, 2004 Mar-Apr, 19(2), 195 - 8
Maternal mortality following diagnostic 2nd-trimester amniocentesis; Elchalal U et al.; We present 2 cases of maternal mortality after transabdominal amniocentesis performed during the 2nd trimester of pregnancy . In both these cases, blood cultures revealed Escherichia coli . Broad-spectrum intravenous antibiotic treatment started immediately after admission to the hospital did not change the rapid progression of the disease . Despite evacuation of the uterus within <10 h from the diagnosis of septic abortion and transfer to the intensive care units to treat multiorgan failure, these patients died . Septic abortion and septic shock following transabdominal amniocentesis are very rare; however, they carry a serious risk to the patients' life . The combination of fever and leukopenia several days after amniocentesis should alert the physician to the evolution of sepsis . Because of the risk involved, information given to the patient prior to amniocentesis should refer to possible fetal complications and to the remote possibility of maternal risks as well .

Shock, 2004 Feb, 21(2), 121 - 5
Antibiotics improve survival in sepsis independent of injury severity but do not change mortality in mice with markedly elevated interleukin 6 levels; Turnbull IR et al.; Genetically identical mice have a heterogeneous response to antibiotic therapy in sepsis, with only a subset deriving therapeutic benefit . We sought to determine whether the severity of a septic insult correlates with the survival benefit conferred by antibiotics . We also sought to determine whether antibiotics given 12 h after injury alter survival in animals predicted to die based upon high interleukin (IL)-6 levels drawn 6 h earlier . Adult male ND4 mice (n = 363) were subjected to double-puncture cecal ligation and puncture (CLP) with a 19-, 21-, or 23-gauge needle . Animals were randomized to receive imipenem or 0.9% NaCl every 12 h after CLP for 5 days . Ten-day survival was 16%, 26%, and 52%, respectively, for untreated animals . Antibiotics decreased the absolute risk of death 17% to 23% regardless of injury severity . In a separate cohort, mice (n = 37) were subjected to single or double-puncture CLP with a 21-gauge needle . IL-6 levels were assayed 6 h postoperatively and mice were followed for survival . Levels greater than 14,000 pg/mL were identified as predicting a 100% mortality (7/7 animals dead) . A third set of mice (n = 94) then underwent double-puncture CLP with either 21-, 23-, or 25-gauge needle and had IL-6 levels measured in a similar fashion . Animals were randomized to receive imipenem or 0.9% NaCl beginning 12 h postoperatively (6 h after IL-6 levels were drawn) and continued for 5 days or until death . Although antibiotics decreased mortality overall, all animals with IL-6 levels greater than 14,000 pg/mL (n = 13) died, regardless of whether they received antibiotics or the gauge of needle used . These results indicate that antibiotics improve outcome in murine sepsis, regardless of injury severity . Furthermore, there is a threshold IL-6 level that can be identified 6 h after sepsis above which animals are destined to die, and antibiotic treatment does not alter their outcome.

Surg Neurol, 2004 Feb, 61(2), 129 - 35; discussion 135
Intraoperative antibiotic prophylaxis in clean spinal surgery: a retrospective analysis in a consecutive series of 973 cases; Mastronardi L et al.; BACKGROUND: Antibiotic prophylaxis in spine surgery is still a debated question, involving medical, ethical, economic, and legal issues . The aim of our retrospective study was to evaluate the safety and effectiveness of an intraoperative protocol of antibiotic prophylaxis . METHODS: During a 3-year period, 973 patients were consecutively operated on for clean spinal operations . Twenty-three percent of the cases involved the cervical spine and 77% the thoraco-lumbar spine; about 90% of patients were operated on for degenerative diseases and the remaining for traumatic lesions or tumors . Patients undergoing operations shorter than 120 minutes received a single-dose of IV ampicillin 1000 mg and sulbactam 500 mg (AS) at induction of anesthesia . In procedures longer than 120 minutes and/or requiring prosthetic materials, an IV single-dose of teicoplanin 400 mg was also administered at the same time . A second intraoperative dose of AS and teicoplanin was administered in operations longer than 4 hours (240 minutes after the first one) and in procedures in which blood loss exceeded 1500 mL . Postoperative prophylaxis has never been performed . RESULTS: The only side effect was a cutaneous rash in 7 cases (0.7%), without any consequence . A wound infection was detected in 9 cases (<1%), all successfully treated with surgical toilette and specific antibiotic treatment . A lumbar discitis was detected in 4 out of 657 microdiscectomies (0.6%) . CONCLUSIONS: Even if this study has the weakness of the retrospective character, our intraoperative antibiotic prophylaxis protocol proved to be safe and efficacious . We hope that these preliminary results will be confirmed by larger prospectic trials.

Am J Rhinol, 2003 Nov-Dec, 17(6), 363 - 8
Intravenous antibiotics for refractory rhinosinusitis in nonsurgical patients: preliminary findings of a prospective study; Anand V et al.; BACKGROUND: Some patients with persistent chronic sinusitis have either had unsuccessful surgery or have simply refused surgery . In nonsurgical candidates, when oral antibiotics and traditional therapy are unsuccessful, home intravenous (i.v.) antibiotics present an effective alternative . METHODS: Forty-five patients were assessed before treatment using a semiquantitative scoring system and visual analog scales to measure major and minor symptoms of rhinosinusitis . Computed tomography (CT) scans were assessed using the Lund-MacKay staging system; nasal endoscopic findings were documented . Seven patients had nasal endoscopy and CT results . Medical diseases known to be associated with rhinosinusitis were documented . Endoscopic-guided culture and sensitivities were obtained . After successful insertion and radiological placement confirmation, home i.v . antibiotics were administered via a peripherally inserted central catheter line . Antibiotic choice was based on the culture and sensitivity reports . Treatment continued for 6 weeks; subsequent cultures were obtained at weeks 3, 6, and 9 . Nasal endoscopy was performed, and rhinosinusitis symptoms were assessed at weeks 3, 6, and 9 . Follow-up CT scans were obtained at week 12 in a subset of patients . RESULTS: Significant improvement in symptom analysis was seen in patients receiving home i.v . antibiotics when previous oral antibiotic treatment and/or surgery had failed . CONCLUSION: Home i.v . antibiotics provide an excellent alternative to surgery for patients who have either had unsuccessful surgery or who have refused surgery.

J Cutan Med Surg . 2004 Jan 23; {Epub ahead of print}
Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment; Altmann S et al.; Background: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses . The disease is mostly located in groin and axilla . As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice . Methods: We report on 20 patients with axillary hidradenitis suppurativa . The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg . Postoperatively, all patients received antibiotic treatment and immobilization of the arm . Physiotherapy started after 2 weeks . Results: No flap complications occurred . The functional and aesthetic results were very satisfactory . Movement of shoulder showed no restrictions . A recurrence with single fistulas was seen in 3 patients . Conclusions: Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence . Only radical debridement offers a cure . The therapy of choice is the radical excision of the affected region and immediate coverage with a flap . Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems . Thus, open granulation is inferior to primary closure by a transposition flap . Using the Limberg flap, the donor site is allowed to be closed primarily.

Clin Infect Dis, 2004 Feb 1, 38(3), 444 - 7 Epub 2004 Jan 13.
Short-term treatment of actinomycosis: two cases and a review; Sudhakar SS et al.; Recommendations for prolonged penicillin treatment of actinomycosis date from the early antibiotic era, when patients often presented with neglected, advanced disease and received interrupted therapy at suboptimal dosages . This report describes cases of esophageal and of cervicofacial actinomycosis treated successfully with short-term antibiotic therapy and reviews the literature . Many patients are cured with <6 months of antibiotic therapy . If short-term antibiotic treatment is attempted, the clinical and radiological response should be closely monitored . Cervicofacial actinomycosis is especially responsive to brief courses of antibiotic treatment.

Clin Infect Dis, 2004 Feb 1, 38(3), 348 - 56 Epub 2004 Jan 13.
Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital; Ruttimann S et al.; We tested a low-cost, multifaceted intervention program comprising formulary restriction measures, continued comprehensive education, and guidelines to improve in-hospital use of antibiotics and related costs . In a short-term analysis, total antibiotic consumption per patient admitted, which was expressed as defined daily doses (DDD), decreased by 36% (P < .001), and intravenous DDDs decreased by 46% (P < .01) . Overall expenditures for antibiotic treatment decreased by 53% (100 US dollars per patient admitted) . The 2 main cost-lowering factors were a reduction in prescription of antibiotics (35% fewer treatments; P < .0001) and more diligent use of 5 broad-spectrum antibiotics (23% vs . 10% of treatments; P = .001) . Quality of care was not compromised . A pharmacy-based, prospective, long-term surveillance of DDDs and costs over 4 years showed an ongoing effect . This comprehensive intervention program, which aimed to reduce antibiotic consumption and costs, was highly successful and had long-lasting effects.

Am J Emerg Med, 2004 Jan, 22(1), 10 - 3
Low risk of infection in selected human bites treated without antibiotics; Broder J et al.; To assess the need for antibiotics in low-risk human bite wounds, a prospective, double-blind, placebo-controlled study involving 127 patients presenting with low-risk human bite wounds over 2 years to a 40,000 visit per year major academic ED was performed . Low-risk bites penetrated only the epidermis and did not involve hands, feet, skin, overlying joints, or cartilaginous structures . Exclusion criteria included age less than 18 years, puncture wounds, immunocompromise, allergy to penicillin or related compound, or bites greater than 24 hours old . Patients were randomly assigned to receive either a cephalexin/penicillin combination or placebo . One hundred twenty-five patients completed the study . Infection developed in 1 of 62 patients receiving placebo (1.6%, 95% confidence interval CI, 0-7.3%) . Infection developed in 0 of 63 patients receiving the cephalexin/penicillin combination (0%, 95% CI, 0-4.6%) . Antibiotic treatment of some low-risk human bite wound could be unnecessary . Infection rates appear similar in low-risk human bite wounds whether treated with antibiotics or placebo.

Curr Treat Options Gastroenterol, 2004 Feb, 7(1), 7 - 11
Tropical Sprue; Westergaard H; Tropical sprue is a disease that causes progressive villus atrophy in the small intestine, similar to nontropical (celiac) sprue . The loss of intestinal villi profoundly affects intestinal absorptive function, and patients with tropical or nontropical sprue present with malabsorption . Whereas the etiology of celiac sprue has been elucidated in considerable detail, the etiology of tropical sprue remains obscure . The favored hypothesis is that the disease is either initiated or sustained by a still-undefined infection . Patients with tropical sprue typically present with macrocytic anemia due to malabsorption of folate and/or vitamin B(12) . Treatment of tropical sprue with folic acid replacement was introduced more than 50 years ago and has become standard medical treatment . Vitamin B(12) replacement is usually added if there is evidence of B(12) deficiency or malabsorption . Treatment of tropical sprue with folate and B(12) cures the macrocytic anemia and the accompanying glossitis, and often results in increased appetite and weight gain . However, even prolonged treatment with these vitamins fails to restore villus atrophy, and malabsorption usually persists . The benefit of antibiotic treatment of tropical sprue was first documented during World War II, when sulfonamides were used to treat epidemics of tropical sprue in British and Italian troops in India . Antibiotic treatment has since become the standard treatment, and tetracycline has replaced sulfonamides . The recommended length of treatment with tetracycline is 6 months and it is given in combination with folate . The treatment has been shown to normalize mucosal structure in the small intestine and resolve malabsorption in most patients with tropical sprue . However, there is a substantial relapse rate in treated patients who return to, or remain in, endemic areas in the tropics.

Zhonghua Er Ke Za Zhi, 2003 Dec, 41(12), 889 - 92
{Early diagnosis of the premature infant nosocomial infection by clinical assessment}; Qi JM et al.; OBJECTIVE: To study the possibility of bacterial infections in the hospital among the premature and low birth weight newborns by scoring their clinical assessments and laboratory examinations . METHODS: From January 2002 to January 2003, 62 newborns with birth-weight less than 2,000 g were divided into two groups, infected group and control group, based on the current diagnostic standards for newborns . We scored the newborns according to the severity of their illnesses based on their clinical manifestations and laboratory examination, and compared the scores obtained before and after effective antibiotic treatment . RESULTS: It was found that the scores were significantly different (P < 0.01) between the infected group and the control group before treatment; while after antibiotic treatment, the difference was no longer significant (P > 0.05) . In the infected group, the scores obtained pre- and post-treatment were significantly different (P < 0.01) . In the control group, in those with the scores >or= 11 before antibiotic treatment, the scores significantly decreased (P < 0.01) after-treatment; but in those with the scores < 11, the score did not decrease (P > 0.05) . These results indicate that the current diagnostic criteria for newborns may not be sensitive enough for premature infants, low birth weight infants and very low birth weight infants . CONCLUSION: Scoring the low birth weight premature infants with their clinical manifestations has the advantages in judging the possibility of infection and monitoring the effectiveness of the anti-infection treatment.

J Infect, 2004 Feb, 48(2), 134 - 8
Evidence based paediatrics: review of BTS guidelines for the management of community acquired pneumonia in children; Kumar P et al.; Community acquired pneumonia is a common illness with significant morbidity and mortality in children and a high cost to society . Guidelines for management in the UK were issued by the British Thoracic Society in 2002 {Thorax 57 (2002) 1} . This review summarises the guidelines with emphasis on aetiology, investigations and antibiotic treatment.

Arch Intern Med, 2004 Jan 12, 164(1), 13 - 6
Is signed consent for influenza or pneumococcal polysaccharide vaccination required?
Kissam S, Gifford DR, Patry G, Bratzler DW.
Each year, thousands of preventable deaths and hospitalizations result from complications of influenza and pneumococcal disease, mostly in elderly persons, despite the availability of vaccines . Obtaining signed consent prior to administering the vaccines represents an obstacle to achieving the Healthy People 2010 goals for vaccinating individuals against influenza and pneumococcal disease . Signed consent is neither legally mandated nor a guarantee that the patient (or proxy) has given informed consent . Nonetheless, many health care providers and institutions currently require signed consent before administering these vaccines . Rather, health care providers should use the Vaccine Information Sheets developed by the Centers for Disease Control and Prevention to inform patients about the risks and benefits associated with these vaccines . Requiring signed consent before administering these low-risk, high-benefit vaccines is inconsistent with the current practice of not requiring signed consent before prescribing other common treatments, eg, antibiotic treatment, whose risk levels are the same or higher.

J Pharm Pharmacol, 2003 Nov, 55(11), 1569 - 75
Repetitive administration of Shaoyao-Gancao-tang to rats restores the bioavailability of glycyrrhizin reduced by antibiotic treatment; He JX et al.; Shaoyao-Gancao-tang (SGT), a traditional Chinese formulation, is often used together with antibiotics such as amoxicillin and metronidazole (AMPC-MET) for the treatment of peptic ulcers in Japan . However, the bioavailability of glycyrrhizin (GL) in SGT is severely reduced by a single administration of AMPC-MET, and the reducing effect continues for 12 days . GL is one of the major pharmacologically important glycosides in SGT and is transformed into the active metabolite 18beta-glycyrrhetic acid (GA) by intestinal bacteria in the gut, followed by absorption of the latter into the blood . In order to reduce the negative effect of AMPC-MET on the bioavailability of GL, the optimum scheduling of the medications was examined . We found that the reduction in the plasma GA concentration and the GL-metabolizing activity in faeces caused by a single dose of AMPC-MET could be sharply attenuated by the repetitive administration of SGT for 4 days . The GA concentration and the GL-metabolizing activity were strongly enhanced by further continuous administration of SGT . These findings suggest that repetitive administration of SGT starting 1 or 2 days after the administration of AMPC-MET speeds the recovery of the bioavailability of GL in SGT . Similar strategies for administering medications may also be useful for combination therapy of antibiotics with other traditional Chinese formulations containing bioactive glycosides.

Arch Dis Child Fetal Neonatal Ed, 2004 Jan, 89(1), F68 - 70
Characteristics of neonates with isolated rectal bleeding; Maayan-Metzger A et al.; OBJECTIVE: To determine the characteristics of full term and preterm neonates with isolated rectal bleeding (IRB), and to follow the outcome of these low risk patients . DESIGN: A retrospective case-control study consisting of 147 cases (83 full term and near term infants and 64 preterm infants) and 147 controls in a single institution . RESULTS: A feeding regimen that did not include breast milk was the only variable found to predict IRB . In full term and near term babies (gestational age >/= 35 weeks), 52.6% of the study group were breast fed compared with 83.1% of the controls (p < 0.0001) . In preterm babies (gestational age </= 34 weeks), 45.9% of the study group were breast fed compared with 74.2% of the controls (p = 0.0014) . No obvious systemic infection cause was detected . None of the patients showed clinical or radiological deterioration in the days after diagnosis of IRB . CONCLUSIONS: The outcome of a group of low risk neonates with IRB was excellent . It is questionable whether antibiotic treatment is required and feeding needs to be stopped . Breast feeding, even if only partial, should be encouraged.

J Microbiol Methods, 2004 Jan, 56(1), 63 - 71
Use of a Taqman PCR to determine the response of Mycoplasma haemofelis infection to antibiotic treatment; Tasker S et al.; A quantitative Taqman polymerase chain reaction (PCR) assay was used to evaluate the response of Mycoplasma haemofelis experimentally infected cats to three antibiotic treatment regimes . Sixteen cats were intravenously inoculated with M . haemofelis from a chronically infected donor . The cats were randomly assigned to one of four treatment groups each containing four cats: oral doxycycline at 10 mg/kg/day for 14 days, oral enrofloxacin at 5 mg/kg/day for 14 days, oral enrofloxacin at 10 mg/kg/day for 14 days, and an untreated control group . DNA, extracted from blood samples collected on days 0, 7, 14, 21, 25, 28, 32, 35, 42 and 54 post-inoculation (PI), was subjected to quantitative Taqman PCR . The M . haemofelis copy number was significantly lower in the doxycycline group (P=0.008), the 5 mg/kg/day enrofloxacin group (P=0.006) and the 10 mg/kg/day enrofloxacin group (P=0.005) compared to the untreated control group . No significant differences were found between any of the three antibiotic treated treatment groups . All three antibiotic treatment regimes evaluated in this study were effective at reducing M . haemofelis copy number.

Cell Microbiol, 2004 Feb, 6(2), 117 - 27
Chlamydia pneumoniae and atherosclerosis; Belland RJ et al.; Exposure to Chlamydia pneumoniae is extremely common, and respiratory infections occur repeatedly among most people . Strong associations exist between C . pneumoniae infection and atherosclerosis as demonstrated by: (i) sero-epidemiological studies showing that patients with cardiovascular disease have higher titres of anti-C . pneumoniae antibodies compared with control patients; (ii) detection of the organism within atherosclerotic lesions, but not in adjacent normal tissue by immunohistochemistry, polymerase chain reaction and electron microscopy and by culturing the organism from lesions; and (iii) showing that C . pneumoniae can either initiate lesion development or cause exacerbation of lesions in rabbit and mouse animal models respectively . The association of this organism with atherosclerosis has also provided sufficient impetus to conduct a variety of human secondary prevention antibiotic treatment trials . The results of these studies have been mixed and, thus far, no clear long-lasting benefit has emerged from these types of investigations . Studies of C . pneumoniae pathogenesis have shown that the organism can infect many cell types associated with both respiratory and cardiovascular sites, including lung epithelium and resident alveolar macrophages, circulating monocytes, arterial smooth muscle cells and vascular endothelium . Infected cells have been shown to exhibit characteristics associated with the development of cardiovascular disease (e.g . secretion of proinflammatory cytokines and procoagulants by infected endothelial cells and foam cell formation by infected macrophages) . More detailed analysis of C . pneumoniae pathogenesis has been aided by the availability of genomic sequence information . Genomic and proteomic analyses of C . pneumoniae infections in relevant cell types will help to define the pathogenic potential of the organism in both respiratory and cardiovascular disease.

Rev Prat, 2003 Oct 31, 53(16), 1785 - 9
{Prostatitis}; Botto H; A very frequent disease, prostatitis is always infectious in the acute form and rarely so in the chronic form (less than 10%) . The management of acute prostatitis requires simplicity and efficiency . Fluoroquinolones taken for 3 weeks are the treatment of reference . The identification of chronic prostatitis requires the Meares and Stamey test, and the use of the 1995 NIH classification . Antibiotic treatment when indicated (confirmed or suspected infectious forms) has to be very prolonged (4 to 6 weeks) . There are neither tests nor diagnostic markers for the non-infectious forms (chronic pelvic pain syndrome) . From this fact, diagnostic explorations and the eventual treatments vary greatly and are currently not codified.

BMC Fam Pract . 2003 Dec 30;4(1):20.
The knowledge and expectations of parents about the role of antibiotic treatment in upper respiratory tract infection--a survey among parents attending the primary physician with their sick child; Shlomo V et al.; BACKGROUND: Upper respiratory tract infections (URTI) are common . The etiologic factor is usually viral, but many physicians prescribe antibiotics . We aimed to evaluate parents' expectations of and knowledge about the role of antibiotics in childhood URTI . METHODS: The study was conducted in thirteen primary care pediatric clinics . Parents of children aged 3 months to 6 years who attended with URTI symptoms were included when it was the first attendance in the current illness . Questionnaire about the current illness, reasons for attending and expectations from the visit, knowledge about URTI was filled before the visit . RESULTS: In 122 visits the average age was 2.8 +/- 1.9 years . The main reasons for the visit were to avoid complications (81%) and to be examined (78%) . Expected treatment was: cough suppressants (64%), anti-congestants (57%), paracetamol (56%), natural remedies (53%) and antibiotics (25%) . In 28% the child had received antibiotics in past URTI . Only 37% thought that antibiotics would not help in URTI and 27% knew that URTI is a self-limited disease . 61% knew that URTI is a viral disease . Younger parental age and higher education were associated with lower expectations to receive antibiotics (p = 0.01, p < 0.005 respectively) . While previous antibiotic treatment (p < 0.001), past perceived complications (p = 0.05) and the thought that antibiotics help in URTI (p < 0.001) were associated with a greater expectation for antibiotics . CONCLUSIONS: A quarter of the parents attending the physician with URTI are expecting to get antibiotics . Predictors were lower education, older parental age, receiving antibiotics in the past and the belief that antibiotics help in URTI.

J Oral Maxillofac Surg, 2004 Jan, 62(1), 3 - 8; discussion 9
Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity?
Poeschl PW, Eckel D, Poeschl E.
PURPOSE: We evaluated the need for prophylactic postoperative oral antibiotic treatment in the removal of asymptomatic third molars . MATERIALS AND METHODS: In a prospective study of more than 30 months, a total of 528 impacted lower third molars were surgically removed in 288 patients . All patients were referred to our department by a dentist or a general practitioner . No patient showed any sign of pain, inflammation, or swelling at the time of removal . Three groups were established . In the first group, antibiotic treatment with amoxicillin/clavulanic acid as an oral medication was carried out for 5 days postoperatively . In the second group, we used clindamycin . In the third group, the patients received no antibiotic treatment . Clinical and radiologic factors were recorded for each case, and the rationale for assigning the patients to the groups was strictly random . The surgical technique was the same in all cases, and the follow-up period was 4 weeks . Parameters that were evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects . RESULTS: We could not find any significant difference between the 3 groups regarding the evaluated parameters, but in 69.6% of the patients with dry socket, the teeth were partially erupted, which showed a significant difference . CONCLUSIONS: The results of our study show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to a better wound healing, less pain, or increased mouth opening and could not prevent the cases of inflammatory problems after surgery, respectively, and therefore is not recommended for routine use.

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