Antibiotic treatment

J Infect Dis, 2002 Nov 15, 186(10), 1430 - 7 Epub 2002 Oct 23.
Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment; Bockenstedt LK et al.; Xenodiagnosis by ticks was used to determine whether spirochetes persist in mice after 1 month of antibiotic therapy for vectorborne Borrelia burgdorferi infection . Immunofluorescence and polymerase chain reaction (PCR) were used to show that spirochetes could be found in Ixodes scapularis ticks feeding on 4 of 10 antibiotic-treated mice up to 3 months after therapy . These spirochetes could not be transmitted to naive mice, and some lacked genes on plasmids correlating with infectivity . By 6 months, antibiotic-treated mice no longer tested positive by xenodiagnosis, and cortisone immunosuppression did not alter this result . Nine months after treatment, low levels of spirochete DNA could be detected by real-time PCR in a subset of antibiotic-treated mice . In contrast to sham-treated mice, antibiotic-treated mice did not have culture or histopathologic evidence of persistent infection . These results provide evidence that noninfectious spirochetes can persist for a limited duration after antibiotics but are not associated with disease in mice.

Thorax, 2002 Nov, 57(11), 926 - 9
Airways in cystic fibrosis are acidified: detection by exhaled breath condensate; Tate S et al.; BACKGROUND: The loss of cystic fibrosis transmembrane conductance regulator (CFTR) mediated chloride conductance does not fully explain the diverse pathologies evident in patients with cystic fibrosis (CF) . Bicarbonate (HCO(3)(-)) secretion is also impaired in CFTR expressing tissues and CFTR is thought to regulate HCO(3)(-) secretion at the apical membrane of epithelial cells . We hypothesised that the epithelial lining fluid (ELF) of patients with CF would be acidified and that this may be worsened during an infective exacerbation due to the increased inflammatory burden . METHODS: pH and nitrite levels in exhaled breath condensate (EBC) from 12 healthy non-smoking controls and 30 patients with CF (11 of whom were in an infective exacerbation) were measured . A further nine patients were studied before and after intravenous antibiotic treatment for an exacerbation of CF . RESULTS: The pH of EBC was significantly lower in patients with stable CF than in controls (5.88 (0.32) v 6.15 (0.16), p=0.017), and was further reduced in CF patients with an exacerbation (5.32 (0.38), p=0.001) compared with stable CF patients . EBC pH increased significantly following antibiotic treatment from 5.27 (0.42) to 5.71 (0.42), p=0.049) . Nitrite levels in EBC were increased in CF patients with an exacerbation compared with control subjects (4.4 (4.0) micro m v 1.6 (1.6) micro m p=0.047) . No correlation was found between EBC pH and nitrite levels . CONCLUSIONS: These findings support the hypothesis that airway acidification occurs in CF . This acidity is in part a function of inflammation as the pH of the EBC of patients increased significantly with treatment of an exacerbation, although not to control levels . Acidic pH of the ELF may play a role in the pathophysiology of CF lung disease and requires further investigation.

Yonsei Med J, 2002 Oct, 43(5), 573 - 8
Acute bacterial meningitis as a complication of otitis media and related mortality factors; Geyik MF et al.; The aim of this study was to evaluate the characteristics of patients with acute bacterial meningitis (ABM) developed secondary to acute and chronic otitis media (OM) . Between 1991 and 2001, among 269 adult patients with ABM, 56 who were secondary to OM were included in the study . We reviewed the charts of patients who were diagnosed as ABM following acute or chronic OM . Risk factors associated with mortality were determined by using a logistic regression model . The mean age of the patients, 38 male and 18 female, was 25.8 +/- 10.8 years (range 14 - 65) . Forty-four of these cases (79%) have had chronic OM, of whom 19 (43% of the 44) have also had chronic mastoiditis and 12 (27% of the 44) acute OM . Twenty-three patients (41%) died, during either hospitalization or the follow-up period . Univariate analysis revealed comatose mental status on admission, inappropriate antibiotic treatment before admission, and elevated erythrocyte sedimentation rate (ESR) as significant risk factors for mortality . In multifactorial analysis, comatose mental status (OR=42.5, CI=6.4-280.1, p=0.001) and elevated ESR (OR=1.0, CI=1.01-1.07; p=0.005) remained as significant predictors for mortality . In conclusion, the primary sources of infection leading to the development of ABM should be investigated carefully to reduce the morbidity and mortality rates . It is hoped that this study will raise awareness among general practitioners and otolaryngologists concerning the role of ABM as one of the most important complications of OM.

Z Geburtshilfe Neonatol, 2002 Sep-Oct, 206(5), 193 - 8
{Q Fever in pregnancy: a case report and review of the literature}; Hellmeyer L et al.; Endemic occurrence of Q fever among persons in close contact with domestic animals is well known in some rural regions of Germany . The prevalence of antibodies indicating acute Q fever in pregnancy reported in the literature varies between 0.2 % and 4.7 % of the screened population . Q fever in pregnancy initially manifests as placentitis and often leads to premature birth (30 %), growth restriction (46 %), spontaneous abortion (22 %) or fetal death in utero (7 %) . Some impairment of pregnancy is observed in over 70 % of cases with seroconversion during pregnancy . Thus Q fever serology should be tested in all pregnant women presenting with atypical pneumonia and/or prolonged fever of unknown etiology . It is of interest that medical staff members in contact with Cociella burnetii infected pregnant women are also at risk of acquiring an acute Q fever infection . We report about a patient presenting with confirmed acute and later chronic Q fever during pregnancy in whom antibiotic treatment with rifampicin and clarithromycin proved to be effective and led to the vaginal delivery of a premature but healthy infant . We believe that maternal serum screening for transmissible infections should also include Q fever serology in certain rural regions.

Crit Care Med, 2002 Oct, 30(10), 2355 - 8
Floating aortic thrombus in systemic aspergillosis and detection by transesophageal echocardiography; Grothues F et al.; After immunosuppressive treatment for a colitis ulcerosa, a 49-yr-old man developed signs of systemic aspergillosis with subsequent septic shock and encephalitis . For recurrent signs of thromboembolism, transesophageal echocardiography was performed and revealed a large floating thrombus of the aortic arch . Despite appropriate antibiotic treatment, the patient died a few days later suffering from adult respiratory distress syndrome . The appearance of aortic thrombi concomitant to systemic fungal infection rarely has been reported . The present case is the first report of in vivo detection of large vessel involvement in systemic aspergillosis by transesophageal echocardiography . In our opinion, transesophageal echocardiography is the method of choice for bedside diagnosis of this rare complication in critically ill patients.

Spine, 2002 Oct 1, 27(19), E423 - 7
Polysegmental spondylodiscitis and concomitant aortic aneurysm rupture: case report with 3-year follow-up period; Miltner O et al.; STUDY DESIGN: A case report describing a patient with spondylodiscitis of the thoracic and lumbar spine complicated by rupture of an abdominal aortic aneurysm and aggravation of neurologic symptoms is presented . OBJECTIVE: To present a cardiovascular complication worsening the clinical condition during conservative spondylodiscitis therapy, and to describe a minimally invasive treatment regimen for both spondylodiscitis and aortic aneurysm rupture in multimorbid patients at high risk for complications or refusal of surgery . SUMMARY OF BACKGROUND DATA: Few articles describe minimally invasive treatment of spondylodiscitis . Some available reports describe neurologic symptoms resulting from spinal cord ischemia in aortic aneurysm rupture . No data were found describing simultaneous therapy for spondylodiscitis and rupture of aortic aneurysm . METHODS: Therapy consisted of CT-guided percutaneous drainage of the spondylodiscitis and parenteral antibiotic treatment combined with immobilization and minimally invasive endoluminal exclusion of the aortic aneurysm with a bifurcated stent graft . RESULTS: Effective therapy for polysegmental spondylodiscitis on the one hand and contained rupture of aortic aneurysm on the other are presented . The successful clinical outcome after conservative orthopedic therapy and vascular intervention has been followed for 3 years . CONCLUSIONS: In older patients, spondylodiscitis may be complicated by other underlying diseases . Pain and neurologic symptoms may occur secondarily to concomitant illnesses instead of being caused by the inflammation itself . Minimally invasive therapy is shown to be an effective alternative to surgery in older and multimorbid patients with spondylodiscitis and contained aortic aneurysm rupture.

J Immunol, 2002 Nov 1, 169(9), 5308 - 14
Down-regulation of intestinal lymphocyte activation and Th1 cytokine production by antibiotic therapy in a murine model of Crohn's disease; Bamias G et al.; Resident intestinal bacteria likely play an important role in the pathogenesis of Crohn's disease through their interaction with the gut immune system . SAMP1/YitFc mice spontaneously develop chronic, discontinuous, transmural ileitis with many features similar to Crohn's disease . The aim of this study was to determine the effects and elucidate the mechanisms of action of antibiotic treatment in the SAMP1/YitFc mouse model of ileitis . Mice were treated orally with ciprofloxacin and metronidazole before the development of ileitis (prevention protocol) or after ileitis was fully established (treatment protocol) . Terminal ilea were harvested for histological scoring, and lamina propria and mesenteric lymph node cells were isolated for analysis of activation markers and cytokine production . Antibiotic therapy significantly decreased the severity of ileitis both in the prevention (40% reduction, p < 0.05) and the treatment (25% reduction, p < 0.01) protocols, compared with untreated, control mice . These effects were associated with a decreased percentage of CD4(+)/CD45RB(high) lymphocytes in mesenteric lymph nodes of antibiotic-treated mice, as well as decreased production of IFN-gamma (prevention: 0.53 +/- 0.21 vs 1.84 +/- 0.04 ng/ml, p < 0.05; treatment: 8.4 +/- 0.4 vs 12.4 +/- 0.7 ng/ml, p < 0.005) and TNF (prevention: 61.5 +/- 13 vs 134 +/- 19 pg/ml, p < 0.01; treatment: 333.5 +/- 11 vs 496 +/- 20 pg/ml, p < 0.001) . The number of activated lamina propria lymphocytes was also reduced after antibiotic treatment . In conclusion, antibiotic therapy significantly ameliorates the severity of ileitis in SAMP1/YitFc mice by a mechanism involving down-regulation of activated gut lymphocytes and inhibition of intestinal Th1 cytokine production.

J Laryngol Otol, 2002 Aug, 116(8), 639 - 41
Cervical necrotizing fasciitis with thoracic extension after total laryngectomy; Beerens AJ et al.; Cervical necrotizing fasciitis (CNF) with thoracic extension is rare . It has never been reported in laryngectomized patients . A case of fatal CNF in a laryngectomized patient equipped with a voice prosthesis is presented . Diagnosis and treatment are discussed . CNF with thoracic extension was diagnosed on clinical picture, computed tomography (CT) and biopsies were taken just above the tracheostoma . Antibiotic treatment was started and extensive debridement of the affected tissues performed . A minor extension to the left pleura was considered irresectable . Irradical debridement and the impossibility of administering hyperbaric oxygen therapy caused death within two day after presentation . CNF is a rare disease and to our knowledge, has never been reported after total laryngectomy . This case emphasizes the need for early antibiotic treatment and radical surgical resection of the affected tissues.

Neurosurgery, 2002 Nov, 51(5), 1145 - 51; discussion 1151-2
Management of intracranial infectious aneurysms: a series of 16 cases; Phuong LK et al.; OBJECTIVE: The purpose of this study was to better define the management of intracranial infectious aneurysms . METHODS: We present a retrospective review of the management of 16 patients with intracranial infectious aneurysms . The mean follow-up period was 86 months . RESULTS: None of the patients had a rehemorrhage during antibiotic treatment . The mortality and long-term outcome from ruptured intracranial infectious aneurysms may be better than previously thought . There was no significant difference in long-term outcome between patients with single or multiple infectious aneurysms or between patients who underwent surgical resection and those who were treated only with antibiotics . CONCLUSION: Operative treatment should be pursued for patients with ruptured infectious aneurysms . Patients with unruptured intracranial infectious aneurysms should be observed during antibiotic therapy and followed up with cerebral angiography . Surgical resection should be considered if the aneurysm enlarges and the patient's general medical condition allows general anesthesia to be tolerated.

Nihon Kokyuki Gakkai Zasshi, 2002 Jul, 40(7), 558 - 63
{Usefulness of sputum Gram staining in community-acquired pneumonia}; Sato T et al.; To evaluate the usefulness of sputum gram staining in community-acquired pneumonia (CAP), we reviewed 144 cases requiring hospitalization in the last 4 years . The sensitivity was 75.5%, specificity 68.2%, positive predictive value 74.1%, negative predictive value 69.8%, positive likelihood ratio 2.37, negative likelihood ratio 0.36 and accuracy 72.2% in 97 cases . Both sputum gram staining and culture were performed . Concerning bacterial pneumonia (65 cases), we compared the Gram staining group (n = 33), which received initial antibiotic treatment, based on sputum gram staining with the Empiric group (n = 32) that received antibiotics empirically . The success rates of the initial antibiotic treatment were 87.9% vs . 78.1% (P = 0.473); mean hospitalization periods were 9.67 vs . 11.75 days (P = 0.053); and periods of intravenous therapy were 6.73 vs . 7.91 days (P = 0.044), respectively . As for initial treatment, penicillins were used in the Gram staining group more frequently (P < 0.01) . We conclude that sputum gram staining is useful for the shortening of the treatment period and the appropriate selection of initial antibiotics in bacterial pneumonia . We believe, therefore, that sputum gram staining is indispensable as a diagnostic tool CAP.

Bone Marrow Transplant, 2002 Oct, 30(8), 491 - 6
Late G-CSF after allogeneic bone marrow or peripheral blood stem cell transplantation: a prospective controlled trial; Himmelmann B et al.; Granulocyte colony-stimulating factor (G-CSF) is widely used to accelerate neutrophil recovery after allogeneic BMT or PBSC transplantation . The optimal time to start G-CSF treatment is not known . Forty-two patients undergoing allogeneic BMT or PBSC transplantation for hematological malignancies received G-CSF either on day 6 or on day 9 post transplant . The time to hematological recovery was monitored and the two groups were compared with respect to peritransplant morbidity and mortality . Recovery of the neutrophil counts to >0.1 x 10(9)/l, > 0.5 x 10(9)/l and >1.0 x 10(9)/l were not significantly different in either group . There was no difference in recovery of red blood cell and platelet counts and no difference between the two groups with respect to the number of febrile days or number of days on antibiotic treatment . Documented bacterial, viral or fungal infections did not occur more often when G-CSF treatment was started on day 9 . Delaying treatment with G-CSF resulted in a significant reduction in the length of treatment from 13 to 10 days (23.1% reduction) . Reducing the length of the treatment by 3 days lowered the costs by 395.40 Euro per patient . Delaying G-CSF treatment and starting on day 9 after BMT or PBSC transplantation is safe and results in a clear economic benefit.

Infect Immun, 2002 Nov, 70(11), 6107 - 13
Local delivery of the viral interleukin-10 gene suppresses tissue inflammation in murine Pneumocystis carinii infection; Ruan S et al.; The relationship between tissue inflammation and clearance of the opportunistic pathogen Pneumocystis carinii is poorly understood . We asked whether the anti-inflammatory cytokine interleukin-10 (IL-10) is released during the host response to infection with P . carinii and whether local delivery of the IL-10 gene could suppress tissue inflammatory responses without compromising clearance of infection . Control and CD4-depleted mice were inoculated with P . carinii, and at serial intervals after inoculation, lung tissue was assayed for IL-10 by enzyme-linked immunosorbent assay . We found that IL-10 was released in lung tissue in control mice and was present in higher concentrations in CD4-depleted mice with progressive infection . Control and CD4-depleted mice were then pretreated with 10(9) PFU of intratracheally administered adenoviral vector containing the viral IL-10 gene or the luciferase gene followed by inoculation with P . carinii . Pretreatment with viral IL-10 did not alter clearance of infection in control mice or severity of infection in CD4-depleted mice but did decrease tissue inflammation . We then asked whether gene transfer of viral IL-10 could decrease tissue inflammation during immune reconstitution . In these experiments, immunodeficient scid mice were inoculated with P . carinii and were heavily infected after 4 weeks . When these mice are immunologically reconstituted by intravenous administration of spleen cells from normal mice, a hyperinflammatory reaction developed in lung tissue, associated with high mortality . In comparison to control mice, mice treated with viral IL-10 prior to reconstitution showed significantly decreased lung wet weight, bronchoalveolar lavage fluid (BALF) lactate dehydrogenase, and BALF neutrophils . In contrast, infection intensity, as measured by PCR for P . carinii rRNA, was unchanged between the IL-10 and luciferase groups . Survival was also improved in the IL-10-treated mice . We conclude that release of IL-10 is part of the host response to infection with P . carinii and that gene therapy with viral IL-10 can lessen excessive tissue inflammation without altering pathogen clearance . In the setting of immune reconstitution and P . carinii pneumonia, pretreatment with the viral IL-10 gene decreases excessive tissue inflammation and improves survival . These results are relevant to acute respiratory failure after initiation of antibiotic treatment for human P . carinii pneumonia and to immune reconstitution syndromes in human immunodeficiency virus-positive patients started on highly active antiretroviral therapy.

Eur J Surg, 2002, 168(5), 264 - 9
Appendiceal abscesses: primary percutaneous drainage and selective interval appendicectomy; Lasson A et al.; OBJECTIVE: To present our results of non-surgical primary management of appendiceal abscesses using ultrasonic percutaneous drainage under local anaesthesia, and selective interval appendicectomy . DESIGN: Retrospective study . SETTING: University hospital, Sweden . SUBJECTS: 24 patients with appendiceal abscesses 3-12 cm in size . INTERVENTIONS: Primary ultrasonic percutaneous drainage under local anaesthesia, antibiotic treatment, and selective surgical treatment . MAIN OUTCOME MEASURES: Long-term follow-up . RESULTS: All patients had their abscesses drained successfully without complications . One patient continued to have fever, but eventually responded to conservative treatment and in one the bowel was perforated by the drain but again this was treated conservatively . Four abscesses recurred . Seven patients underwent planned interval appendicectomy . Another three patients were also operated on-one for caecal adenocarcinoma, and two for persisting symptoms and enterocutaneous fistulas . CONCLUSIONS: Appendiceal abscesses can be effectively drained percutaneously using ultrasound-guided drainage under local anaesthesia, without complications . Recurrent appendicitis is common, and malignancy is a substantial risk in elderly patients . Modern laparoscopic appendicectomy and early postoperative discharge makes interval appendicectomy a valid treatment option after primary non-surgical management of appendiceal abscesses.

Acta Neurol Scand, 2002 Nov, 106(5), 253 - 7
Peripheral neuropathy in acrodermatitis chronica atrophicans - effect of treatment; Kindstrand E et al.; Forty-seven patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA) and with objective neurological and/or neurophysiological findings were followed up after antibiotic treatment with dermatological, serological, neurological and neurophysiological controls . Despite a good therapeutic effect on ACA lesions, specific antibody values and symptoms of irritative nerve lesions, the objective neurological and neurophysiological findings of nerve deficit remained unchanged . There was no progress of neuropathy findings during the follow-up time . Our interpretation of the results is that the remaining neuropathy signs after treatment of ACA are neurological sequelae and not manifestations of persisting Borrelia infection.

Clin Chest Med, 2002 Sep, 23(3), 643 - 53
Mycobacterium avium complex pulmonary disease in patients with pre-existing lung disease; Aksamit TR; Patients with MAC-PD and pre-existing lung disease are a distinct group from the more common and recently recognized group of predominantly middle- to older-aged women without pre-existing lung disease . Those with pre-existing disease are expected to have more sputum positivity and slower conversion of sputum with treatment, and they may require combined medical treatment with surgical resection for optimal results . Attention to bronchial hygiene, avoidance of unnecessary use of macrolides, and treatment of underlying esophageal and lung disease can result in marked symptomatic improvement in many cases . Appropriate consideration must be given to mycobacterial antibiotic treatment, and awareness must be maintained for other processes such as bronchogenic cancer in select groups of high-risk patients.

J Am Geriatr Soc, 2002 Oct, 50(10), 1681 - 8
Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment; van der Steen JT et al.; OBJECTIVES: To assess suffering in demented nursing home patients with pneumonia treated with antibiotics or without antibiotics . This study should provide the first empirical data on whether pneumonia is a "friend" or an "enemy" of demented patients and promote a debate on appropriate palliative care . DESIGN: Prospective cohort study . SETTING: Psychogeriatric wards of 61 nursing homes in the Netherlands . PARTICIPANTS: Six hundred sixty-two demented patients with pneumonia treated with (77%) or without (23%) antibiotics . MEASUREMENTS: Using an observational scale (Discomfort Scale-Dementia of Alzheimer Type), discomfort was assessed at the time of the pneumonia treatment decision and periodically thereafter for 3 months or until death . (Thirty-nine percent of patients treated with antibiotics and 93% of patients treated without antibiotics died within 3 months.) Physicians also offered a retrospective judgment of discomfort 2 weeks before the treatment decision . In addition, pneumonia symptoms were assessed at baseline and on follow-up . Linear regression was performed with discomfort shortly before death as an outcome . RESULTS: A peak in discomfort was observed at baseline . Compared with surviving patients treated with antibiotics, the level of discomfort was generally higher in patients in whom antibiotic treatment was withheld and in nonsurvivors . However, these same patients had more discomfort before the pneumonia . Breathing problems were most prominent . Shortly before death from pneumonia, discomfort increased . Discomfort was higher shortly before death when pneumonia was the final cause of death than with death from other causes . CONCLUSION: Irrespective of antibiotic treatment, pneumonia causes substantial suffering in demented patients . Adequate symptomatic treatment deserves priority attention.

Tidsskr Nor Laegeforen, 2002 Aug 20, 122(19), 1864 - 6
{Is antibiotic prophylaxis in Cesarean section necessary?}; Olsen IP et al.; BACKGROUND: A Cochrane Review from October 1998 recommends prophylactic antibiotics for all women undergoing elective and non-elective caesarean section . This is expected to reduce the frequency of postoperative endometritis by two thirds to three quarters . In this study we evaluate the infection rate after caesarean section in a hospital where prophylactic antibiotics are given only to high-risk groups . METHODS: Case records of 344 patient delivered by caesarean section were studied . 30 days after the operation, 83% answered a questionnaire about wound infection . RESULTS: In all, 39% received prophylactic antibiotics . 33 patients (9.6%) developed post-cesarean infections; only 17 were given antibiotic treatment . One patient had endometritis . There were no significant differences with regard to infections between the elective and the non-elective groups (p = 0.63), or between those receiving and those not receiving antibiotic prophylaxis (p = 0.84) . CONCLUSION: The policy of selective use of prophylactic antibiotics for caesarean sections has been successful in our hospital . This study does not permit conclusions as to whether selective prophylactics is a better alternative than routine prophylactics, but the results question whether the recommendation in the Cochrane Review is the best choice for all delivery units.

Rhinology, 2002 Sep, 40(3), 118 - 21
Histological comparison of nasal polyposis in black African, Chinese and Caucasian patients; Lacroix JS et al.; We have compared the histological aspects of nasal mucosa biopsies (n = 130) obtained during bilateral polypectomy and ethmoidectomy performed in black African (n = 50), Chinese (n = 30) and Caucasian patients (n = 50) suffering from bilateral nasal polyposis (NP) . The three groups of patients were matched for age and sex . The African and Chinese patients did not receive any medical treatment before endoscopic nasal surgery (ENS) . All Caucasian patients were treated with corticosteroid nasal spray (400 mg/day) for 6 months . In the absence of subjective and objective clinical improvement, ENS was performed after antibiotic treatment for 10 days and prednisolone 1 mg/kg/day for 5 days . Clinical staging of the NP was graded from I to III (I = polyps limited to the middle meatus, II = polyps extending beyond the middle meatus, and III = polyps occupying the entire nasal cavity) . Stage I NP was present in 22% of the Caucasians and 30% of the Chinese . Stage II was found in 58% of the Caucasians, 56% of the Chinese and 8% of the Africans . Stage III was found in 92% of the Africans, while only 20% of the Caucasians and 14% of the Chinese patients had stage III . The extent of submucosal oedema and number of mast cells were similar for the three groups of patients . A significantly greater number of eosinophils were observed in African polyps . Lymphocytes as well as plasmocytes were rare in African but abundant in polyps from both Chinese and Caucasian . Ulceration of the overlying epithelium of the polyps was observed in 20% of the African and 10% of both Chinese and Caucasians patients . We did not find any significant thickening of the basal membrane . We cannot exclude the possibility that the histological difference observed between African and Chinese polyps is related to the very common use among the Chinese population of topical intranasal treatment according to their traditional medicine practices . Since no major histological difference was found in the nasal mucosa and polyps obtained from the three groups of patients, NP in African, Chinese and Caucasian patients is very probably a similar inflammatory disease in all three ethnic groups.

Dev Sante, 1995, (115), 12 - 5
{Postpartum infections}; Guyard-boileau B; PIP: The unexpected occurrence of a fever higher than 38 degrees Celsius at least twice in 48 hours after childbirth is a common problem . A well-executed clinical examination of a patient with a high fever is necessary to determine the origin of the infection . It is necessary to remain vigilant because it could be a sign of severe infection threatening a mother's life . The fever can sometimes remain moderate while the infection progresses at lightning speed . This is especially the case in weak patients (e.g., those with tuberculosis, AIDS, or malnutrition); thus it will be necessary to keep an attentive eye on them . Major causes to be familiar with and to recognize include malaria (always to be considered), uterine infection (the most common postpartum infection), kidney infection, tender breasts, pneumonia, meningitis, or appendicitis . Things health workers should consider if they suspect uterine infection are birth history, endometritis, and the fact that, in the absence of treatment, the infection can spread to the Fallopian tubes and eventually to the general circulation (septicemia) . Special cases include uterine infections accompanied by retention of placental debris or membranes, fever after abortion, and fever after cesarean section . Health workers must consider all cases of retention, even those without a fever, as a potential infection . They must administer antibiotic treatment within 5 days after emptying the uterus . The treatment of choice for fever following an abortion is 3 g ampicillin for 7 days . In cases of infection after an abortion, health workers should consider uterine perforation and retention . Fever usually occurs 4-5 days after a cesarean section . Antibiotic treatment is usually necessary .

Safe Mother, 1992 Jul-Oct, (9), 4 - 5
What is needed to ensure the health and survival of mother and baby?
{Dos...don'ts...in the case of unexplained high temperature in an IUD user (author's transl)}
Janaud A.

PIP: Fever, like metrorrhagia or pelvic pain, should be a danger signal alerting women with IUDs to seek medical attention without delay . If the temperature is elevated and the clinical signs suggest salpingitis or pelvic infalmmation, the patient should be hospitalized to obtain a diagnostic and therapeutic laparoscopy, intravenous polyantibiotic treatment, and bed rest . A temperature of about 38 degrees Celsius associated with metrorrhagia suggests salpingitis, regardless of other clinical findings, particularly if the patient is under 25, has had several sexual partners, is nulliparous, or is an insulin-dependent diabetic . The diagnosis should be confirmed by laparoscopy . If a virus or flu is as likely to be the cause as a gynecological infection, blood tests and assay of sedimentation rates should be obtained; over 10,000 polynuclear forms, mainly neutrophils, and a sedimentation rate elevated beyond that expected by the fever are significant in diagnosis . A sonogram can be used to rule out endometrial or tubal infection . If doubt persists, the IUD should be removed and a careful laparoscopy performed to assess the extent and nature of lesions . If the IUD is removed, effective replacement contraception should be prescribed . The physician should not ignore a fever in a patient using an IUD, and should be available for consultation immediately . Removal of the device without further treatment is insufficient in case of gynecological infection because of the danger posed to subsequent fertility . The IUD should not be removed without a short and intensive antibiotic treatment . The possibility of a partner with urethritis should not be ignored, and the fever should not be attributed to vaginitis, even if it is a severe case . The possibility of a pregnancy with the device in place should be ruled out . If the strings are not visible, a sonogram should be obtained to locate the device . In diagnosing febrile patients, the possibility of appendicitis and pyelonephritis should also be considered .

Contracept Technol Update, 1981 Mar, 2(3), 29 - 32
Actinomyces in IUD users: management, prevention sparks controversy.
{Infectious complications of intrauterine devices}
De Villartay A, Dubois J, Toulouse R, Bohec M, Lagadec JC, Taillanter L, Grall JY, Mention JE, Even B.

PIP: 5 descriptions of uterine infections caused by an IUD are given . The symptoms are leukorrhea and metroraghia . The antibiotic treatment must be accompanied by removal of the IUD . If symptoms are ignored, the infections become worse, with serious results . 2 of the cases needed drastic surgery and another became sterile . Close surveillance is necessary to avoid such infections and to provide careful treatment if they occur . Prevention should include avoiding IUD use in those who have never given birth, or at the time of curettage .

Support Care Cancer, 2002 Oct, 10(7), 538 - 41 Epub 2002 Aug 10.
Antibiotic prescription for fever episodes in hospice patients; Chen LK et al.; Bacterial infection usually plays an important part in the fever episodes that are common in patients in the hospice palliative care unit . The physicians' attitude to use of antibiotics in such cases is usually complex . We retrospectively studied 535 admissions to a hospice and palliative care unit in a medical center in Taiwan . Ninety-three fever episodes (16.7%) were identified among these admissions, and 79 fever episodes (84.9%) were treated with antibiotics . The Karnofsky performance status (KPS), verbal communication ability (VCA) and Glasgow Coma Scale (GCS) were all significantly compromised in these febrile patients . Although KPS, VCA and GCS were similar among all patients at the date of admission, these parameters became significantly worse in fever episodes that were left untreated than in those treated with antibiotics . Patients without antibiotic treatment showed a shorter mean survival (8.7 +/- 9.9 days vs 14.6 +/- 13.1 days; P = 0.03) and a higher 3-day mortality rate than those patients with antibiotic treatment (50% vs 15.2%; P = 0.015) . In conclusion, appropriate antibiotic use may cause fever to subside and thus decrease the fever-related discomfort . Physicians may tend to withhold antibiotic treatment because of the poorer KPS, VCA, and GCS and poorer estimated prognosis of patients at the time of fever.

Child Health Dialogue, 1996, (3-4), 6 - 7
Managing meningitis and severe malaria; Molyneux E; PIP: Fever is often an indication of a serious illness in children . In areas endemic to malaria, hospital workers should check a febrile child for malaria parasites . Children with a fever associated with meningitis or malaria need immediate attention . To diagnose meningitis: microscopic examination of cerebrospinal fluid obtained by lumbar puncture is the only reliable method . If a febrile child also has a stiff neck, health workers should immediately administer antibiotic treatment without waiting for the results of the lumbar puncture . If available and in epidemic situations, oily chloramphenicol may be administered, since it is effective in a single dose . Treatment with other antibiotics should last for 10 days in children and 14-21 days for young infants . To diagnose malaria in endemic areas: laboratory technicians should examine thick and thin blood films of sick children with fever . Health workers must consider as medical emergencies children who have a slide positive for malaria parasites plus severe anemia, hypoglycemia, deep rapid breathing, any indication of kidney malfunction or failure, or altered consciousness . They should begin antimalarial treatment with quinine, the drug of choice for severe and complicated malaria . In cases of convulsions lasting longer than 5 minutes, health workers should administer anticonvulsants and take actions to prevent aspiration pneumonia . If the fever persists for 14 days or if the child does not emerge from unconsciousness and someone in the family has active tuberculosis, health workers should consider tuberculous meningitis . If a child with malaria has low hemoglobin levels (5 g/dl) and many malaria parasites in the blood and is in heart failure, a blood transfusion (15-20 ml/kg whole blood over 4 hours) and infusion of 1 mg/kg fursemide (to prevent cardiac failure) are needed . If the preceding case has pulmonary edema, a single dose of fursemide at the same dosage is needed to prevent overloading of the circulation . Health workers should closely monitor that intravenous fluids not exacerbate brain swelling .

Adv Contracept Deliv Syst, 1994, 10(3-4), 365 - 8
Contraception and HIV / STD infections; Merino G et al.; PIP: Copper-releasing IUDs cause severe dermatitis (e.g., urticarial eruptions and eczema) in copper-sensitive women . Such exposure of subcutaneous areas is a cofactor for HIV infection . The excessive menstrual bleeding that accompanies IUD use and absorption of virions and infected cells in the semen of HIV-infected males by IUD tails facilitates HIV infection . IUD tails have the highest concentration of HIV in infected women . HIV causes cervicitis in HIV-infected women . The cross reactivity between pelvic inflammatory disease (not rare among copper-IUD users) and sexually transmitted diseases (STDs) increases the risk of HIV infection . Having multiple sex partners is a risk factor of HIV/STD infections . IUDs, diaphragms, latex condoms, and spermicides may cause an allergic reaction in men and women . Condoms made of lamb cecum are an option to men who are allergic to latex . The single greatest factor for HIV infections in Africa is chancroid . The sudden increase of syphilis in the US parallels the sudden increase in HIV transmission . Physicians need to consider the following before treating pregnant STD patients with an antibiotic: possible risk to fetus, altered kinetics and etiology of the STDs, and choice, dose, route, and duration of antibiotic treatment . Family planning services should focus on HIV-infected women, so they can avoid pregnancy . Many public health and family planning clinics offer counseling and HIV-antibody testing . Human semen has various subpopulations of leukocytes . Leukocytes that have enveloped sperm can take sperm antigens to the lymphatic system . The great individual variation in frequency of CD4+ lymphoid cells and monocytes/ macrophages is clinically important in infectivity of semen in HIV-positive men . T4+ lymphocytes are in the semen of fertile and infertile men . HIV carriers should wear condoms . Partial inactivation of HIV after 10 minutes in the condom at 37 degrees Celsius occurs, but inactivation varies by trademark .

J Obstet Gynaecol East Cent Africa, 1982 Mar, 1(1), 25 - 6
Laparoscopic sterilisation at Kenyatta National Hospital, Nairobi; Ngoka WM; PIP: The course in laparoscopy for diagnostic and operative procedures in gynecology, part of a training program in reproductive health for medical personnel at the University of Nairobi, began in June 1979 at Kenyatta National Hospital in Nairobi, Kenya . Between its inception and February 1980, physicians attempted 85 laparoscopic sterilizations using tubal ligation technique (the Falope Ring) . 4 patients underwent a minilaparotomy instead, due to complications, for a success rate of 95.3% . Physicians performed the procedure on an average of 15-20 minutes with 3-5 minutes used for attaching the rings . Only 3 of the laparoscopic patients and all of minilaparotomy patients required extra hospitalization . Most (87.1%) only required an overnight stay . 4.7% went home the same day as the procedure . The leading complaint at follow up (7 days after the procedure) was abdominal pain, but generally no medication was needed . Physicians detected wound infection in only 3 and prescribed only antibiotic treatment . Women's ages ranged from 23- 45 years . Even though most patients knew little to nothing about the procedure itself, they all knew that it was permanent and that it was what they wanted . Most women learned of sterilization from family planning clinics . Average parity was 6.4 (range 2-12) . Prior to sterilization, 17.6% had never used any contraception, but of those that did, most used oral contraceptives (OCs) or OCs and Depo-Provera . The overwhelmingly leading reason for choosing sterilization was had enough children . This study showed that properly trained medical personnel can successfully perform laparoscopic tubal ligation using the Falope Ring and local anesthesia on an outpatient basis . The laprocator and other equipment must be adequately maintained for this technique to be successful, however .

Calcutta Med J, 1989 May-Jun, 86(5-6), 46 - 9
Modern management of secondary amenorrhoea; Banerjee S; PIP: Nonpregnant/nonlactating women who do not menstruate for at least 6 months have secondary amenorrhea . Stress can induce it . Physical changes can also cause it . Oral contraceptives and other drugs can also bring about secondary amenorrhea . Genital tuberculosis (TB) destroys the endometrium thereby causing secondary amenorrhea . Physicians should initiate antibiotic treatment in women with TB . Further, high levels of prolactin stimulated by an overactive anterior pituitary gland or by a pituitary tumor can produce secondary amenorrhea . Physicians should routinely ask these women if they have hot flashes . These may indicate early climacteric indicated by high levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) . Prognosis for a return to menstruation is poor if it is indeed responsible . Further, they should also note changes in hair growth . Any such changes may mean an ovarian tumor, polycystic ovaries, or adrenal disease . If adrenal disease is the cause, the level of serum prolactin should be determined . If a high level of prolactin is found, an X-ray should be taken of the pituitary fossa . If it reveals that the clinoid process had eroded or the floor has doubled, a pituitary tumor may exist . If ovarian cancer is responsible, physicians should begin thyroxine treatment . They should prescribe bromocryptine if a pituitary tumor does not exist yet hyperprolactinemia does . Menstruation should return in about 6 weeks . Low or normal levels of FSH and/or LH may indicate that the hypothalamus does secrete gonadotropic releasing factor . Then physicians should administer clomiphene . Menstruation should return in 1-3 months . Women should continue taking clomiphene until they conceive or withdraw from treatment . Physicians should routinely conduct a examination between treatment courses because enlarged ovaries occur in 7% of the treatment cycles . If clomiphene fails, physicians may try gonadotropin treatment . Some surgical procedures may also treat secondary amenorrhea when other treatment fails .

Aliment Pharmacol Ther, 2002 Oct, 16(10), 1715 - 22
The importance of endoscopic ultrasonography in the management of low-grade gastric mucosa-associated lymphoid tissue lymphoma; Caletti G et al.; BACKGROUND: Anti-Helicobacter pylori therapy has been reported to cause regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma in a high percentage of patients . However, in some patients, these lesions persist despite antibiotic treatment . AIM: To determine the various endosonographic findings that may predict the regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma post-antibiotics . METHODS: Seventy-six patients with Helicobacter pylori-positive gastric mucosa-associated lymphoid tissue lymphoma were studied . Follow-up data were available on 51 patients . All patients were treated with antibiotics . Participants underwent pre- and post-anti-Helicobacter pylori therapy endoscopy with gastric biopsies, followed by endoscopic ultrasonography examination of the stomach . RESULTS: Helicobacter pylori was eradicated in 45 of 51 (88%) patients . At the 2-year follow-up, complete regression of mucosa-associated lymphoid tissue lymphoma was seen in 28 of 51 (55%) patients: 12 of 16 (75%) patients in stage T1m N0, 11 of 19 (58%) patients in stage T1sm N0, four of eight (50%) patients in stages T1m N1 and T1sm N1, and one of four (25%) patients in stage T2 N0 . None of the stage T2 N1 patients achieved clinical regression . CONCLUSIONS: Endoscopic ultrasonography evaluation of gastric mucosa-associated lymphoid tissue lymphoma plays a pivotal role in the initial staging and post-treatment follow-up evaluation of these lesions . Accurate staging is essential in the determination of the optimal treatment modality.

Ann Allergy Asthma Immunol, 2002 Sep, 89(3), 271 - 8
Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis; Nayak AS et al.; BACKGROUND: Mometasone furoate nasal spray (MFNS) 400 microg, twice daily, as adjunctive treatment with oral antibiotic significantly improved symptoms of recurrent rhinosinusitis . OBJECTIVE: To evaluate the effectiveness and safety of MFNS 200 microg, twice daily, and 400 microg, twice daily, compared with placebo as adjunctive treatment with oral antibiotic for acute rhinosinusitis . METHODS: In this multicenter, double-blind, placebo-controlled study, 967 outpatients with computed tomographic scan-confirmed moderate to severe rhinosinusitis received amoxicillin/clavulanate potassium (Augmentin, GlaxoSmithKline, Research Triangle Park, NC) 875 mg, twice daily, for 21 days with adjunctive twice daily MFNS 200 microg, MFNS 400 microg, or placebo nasal spray . Patients recorded scores of six rhinosinusitis symptoms and any adverse events twice daily . Pre- and postcosyntropin-stimulation plasma cortisol levels were measured in a subset of patients at selected study sites . RESULTS: Treatment with MFNS 200 microg or 400 microg, twice daily, produced significantly greater improvements in total symptoms score (primary efficacy variable) day 1 to day 15 average (50% and 51%, respectively) than placebo (44%, P < or = 0.017) . Both doses of MFNS produced significant total symptoms score improvement over placebo by day 4, and maintained efficacy over the entire 21-day study . Relief of individual symptoms showed a similar pattern . Both doses of MFNS were well tolerated, and adverse events were similar to that of placebo . Cosyntropin stimulation showed no evidence of hypothalamic-pituitary-adrenal axis suppression . CONCLUSIONS: As adjunctive therapy to oral antibiotic treatment, MFNS at doses of 200 microg or 400 microg, twice daily, was well tolerated and significantly more effective in reducing the symptoms of rhinosinusitis than antibiotic therapy alone.

Contracept Fertil Sex (Paris) . 1985 May;13(5):766.
{Do's and don'ts concerning an amenorrheic patient after pregnancy termination}; Achard B; PIP: Suggestions are offered for treatment of postabortal amenorrhea . In the absence of bleeding immediately after the procedure, a careful gynecological examination should be conducted to determine the size, consistency, and sensitivity of the uterus and the suppleness and vacuity of the lateral cul-de-sacs . A sonogram should be obtained if the results are abnormal, and a plasma dose of human chorionic gonadotropin should be administered after 12 days in case of doubt . If the sonogram suggests retained uterine contents a 2nd uterine evacuation should be carried out and appropriate antibiotic treatment should be initiated . The possibility of unsuccessful abortion must be considered, as must that of placental retention, hematoma, or ectopic pregnancy . A 2nd intervention should be carried out without hesitation if necessary . In the case of secondary amenorrhea more than 4 weeks after the intervention, a complete gynecological examination should be conducted, a serum human chorionic gonadotropin pregnancy test should be administered, incipient adhesions should be sought through X-ray or laparoscopy and perhaps removed, and symptoms appearing after the abortion, such as insomnia, irritability, weight loss, or consumption of drugs should be investigated . The possibility of another pregnancy should be investigated, adhesions should not be allowed to develop, and the possibility of psychogenic amenorrhea resulting from ambivalence about the abortion should be considered .

J Obstet Gynaecol India, 1970 Feb, 20(1), 30 - 7
The causes of mortality in abortion; Rosario YP; PIP: 17 maternal deaths associated with abortion during 1967-1968 at a New Delhi hospital are analyzed . The mortality rate was .25% of total abortions . Age varied from 18-35 . Only 1 was unmarried . 62.5% admitted to interference . 81% of the patients had signs of sepsis although no pathogenic organisms were found in 2 of the patients with septicemia, presumably as a result of antibiotic treatment . In most of the cases there was a delay in seeking medical attention . Specific causes of death were hemorrhage and sepsis, although the main factors were probably socioeconomic and delay in seeking advice .

Haematologia (Budap), 2002, 32(1), 31 - 7
Eosinophilia in sick neonates; Manoura A et al.; Eosinophilia is common in the neonatal period . However, its causes, pathomechanism and clinical significance are still unknown . Previous reports have described that eosinophilia may be associated with numerous conditions (establishment of an anabolic state, drug reactions, response to foreign antigens, chronic lung disease, erythropoietin treatment and infections) . The aim of this study was to evaluate the possible association of various conditions, especially infection, with eosinophilia and to clarify whether recognition of increase in eosinophil count is of any clinical significance in the management of a sick neonate . Fifty-six neonates with eosinophilia (absolute eosinophil count > 700/mm3) and 55 control neonates matched for gestational age, birth weight and hospitalization days were included in the study . A significant difference between the two groups was found only in blood transfusions, immuno-globulin treatment, specific antibiotic treatment and infectious disease . However, neonates who develop sepsis and are treated with antibiotics and immuno-globulin are more often transfused . It can thus be concluded that the main relationship observed is between eosinophilia and infection whereas the other associations are secondary . The relative risk factor for infection when the absolute eosinophil count is > 700/mm3, is 1.58, with a confidence interval 1.30-1.91 . Eosinophilia seems to be a reliable indicator of sepsis while normal absolute eosinophil count does not exclude infection . Infection should be strongly considered in the evaluation of a sick neonate with eosinophilia.

Int J Pediatr Otorhinolaryngol, 2002 Sep 24, 65(3), 249 - 52
Subdural empyema complicating a concha bullosa pyocele; Marianowski R et al.; Concha bullosa is the most common anatomic variant of the middle turbinate and remains usually asymptomatic . We report a case of concha bullosa pyocele with a subdural empyema in a 11-year-old girl presenting with a subcutaneous tumefaction without neurologic deficit . Computed tomography and magnetic resonance imaging confirmed a subdural empyema communicating with subcutaneous effusion and the presence of a concha bullosa pyocele being responsible for the obstruction of ostiomeatal complex leading to frontal sinusitis . Resection of the middle turbinate with a middle meatotomy and a frontal skin incision combined with an adequate antibiotic treatment allowed this child to recover within 6 weeks.

Dermatol Nurs, 2002 Aug, 14(4), 242 - 6
Overview of treatments for acne; Oprica C et al.; Acne vulgaris is a chronic inflammatory condition of the pilosebaceous units . Antibiotics are widely used in acne therapy and can be administrated topically or systemically . The main negative effect of antibiotic treatment is bacterial resistance to antibiotics.

Hepatogastroenterology, 2002 Sep-Oct, 49(47), 1296 - 7
Helicobacter pylori seroprevalence in Crohn's disease: lack of influence by pharmacological treatment; Guslandi M et al.; BACKGROUND/AIMS: Helicobacter pylori infection has a low prevalence in Crohn's disease, possibly because of sulphasalazine therapy . We investigated Helicobacter pylori seroprevalence in patients with Crohn's disease never treated with sulphasalazine in order to assess the possible role of antibiotic treatment . METHODOLOGY: Two groups of patients with Crohn's disease (group I: subjects treated with ciprofloxacin, metronidazole or both during the last six months; Group II: subjects who were not given antibiotics during the last six months) and a control group of 30 patients with irritable bowel syndrome were considered . IgG anti-H . pylori levels were measured in all patients . RESULTS: Serology was positive respectively in 16.6%, 13.3% and 36.6% of cases in the three groups . CONCLUSIONS: Our findings confirm the Helicobacter pylori infection is infrequent in Crohn's disease . Neither sulphasalazine nor antibiotics appear to play a role.

Ther Umsch, 2002 Aug, 59(8), 435 - 42
{Practical management of diabetic foot}; Schwegler B et al.; Prevention and the correct treatment of the diabetic foot have important social and economic consequences . Risk stratification is essential for choosing the appropriate treatment strategy . History and careful clinical examination identify the risk in each individual patient with diabetes . Peripheral neuropathy (PNP), foot deformation, peripheral arterial disease (PAD) and a history of previous ulcer or amputation are the most important risk factors . PAD must be diagnosed and treated by percutan transluminal angioplasty or bypass surgery where necessary . Primary foot deformation or secondary due to PNP require shoe modifications . Good metabolic control of diabetes and treatment of other cardiovascular risk factors (dyslipidemia, hypertension) delay or prevent the development of PNP and PAD . Therefore an early multidisciplinary approach is essential for each patient with diabetes and foot problems . In the presence of a foot ulcer, it's important to diagnose osteomyelitis by clinical or radiological examination . The choice and duration of antibiotic treatment and surgical intervention depends on the localisation and extension of infection around the ulcer and the presence of osteomyelitis . In case of limb threatening infection, the patient should be referred to a specialized treatment facility immediately.

J Invertebr Pathol, 2002 May, 80(1), 41 - 5
Influence of antibiotics on the offspring production of the Wolbachia-infected parthenogenetic parasitoid Encarsia formosa; Stouthamer R et al.; Three different concentrations of the antibiotic tetracycline in honey were tested for their influence on the offspring production and longevity of the parasitoid wasp Encarsia formosa . Several earlier publications did not provide a conclusive answer on the effect that the Wolbachia have on these wasps . The results of our experiments show that at high tetracycline hydrochloride concentrations in honey (50mg/ml) the antibiotic is toxic to the females, all females died within three days after the antibiotic treatment . The concentration 5mg/ml was less toxic although the treated females also lived shorter and produced less offspring than the control females . At the lowest tested concentration of 1mg/ml there was no significant difference either in offspring production or in longevity between the control and the treated females . The antibiotic treatment at both 5 and 1mg/ml resulted in exclusively male progeny after the first two days of oviposition . These results are consistent with the theory that in species in which all individuals are infected the Wolbachia should not impose a large fitness cost.

Arch Dermatol, 2002 Sep, 138(9), 1145 - 8
Clindamycin for intraincisional antibiotic prophylaxis in dermatologic surgery; Huether MJ et al.; OBJECTIVE: To assess the efficacy of intraincisional clindamycin therapy as an alternative to nafcillin treatment in decreasing the risk of postoperative wound infections in dermatologic surgery . DESIGN: Prospective, double-blinded, randomized, placebo-controlled trial conducted over a 7-month period . SETTING: Three private practice Mohs micrographic surgery referral centers . PATIENTS: A total of 1030 consecutive patients who underwent Mohs micrographic surgery with subsequent reconstruction . INTERVENTIONS: Prior to reconstruction, patients were randomly assigned to receive either intraincisional buffered lidocaine with epinephrine containing clindamycin or buffered lidocaine with epinephrine without clindamycin . Nurses and physicians who scored the wound at follow-up were blinded to the treatment conditions . MAIN OUTCOME MEASURES: Surgical wounds evaluated at the time of suture removal were scored according to a standardized assessment based on erythema, edema, and the presence of purulent discharge . Wounds scored 4 or higher were considered to be infected . Bacterial cultures obtained when indicated were also compared . RESULTS: Of the 1172 surgical wounds included in the study, 29 had wound scores of 4 or higher, 6 in the study group and 23 in the control group (P =.001, Fisher exact test) . Of these 29, 18 had culture-positive infections . Four of these occurred in the study group, and 14 occurred in the control group (P =.02, Fisher exact test) . CONCLUSIONS: The results of this study further support the efficacy of single-dose preoperative intraincisional antibiotic treatment for dermatologic surgery . With the relatively high prevalence of patient-reported penicillin allergies, buffered lidocaine containing clindamycin offers an inexpensive, safe, convenient, and effective alternative.

Med Sci Monit, 2002 Sep, 8(9), ED5 - 16
AIDS research in developing countries: do the ends justify the means?
Clark PA.
Concrete ethical standards for human research are clearly stipulated in both international and national codes of ethics, and are meant to protect human subjects, especially the most vulnerable . A recent clinical study conducted from 1994 to 1997 by Dr . Thomas C, Quinn, M.D . has fueled the debate raging in the scientific community regarding the ethics of clinical AIDS research in developing countries . Quinn's conducted a community-based, randomized, controlled study of 15,127 rural Ugandans to determine whether intermittent antibiotic treatment to reduce the prevalence of other sexually transmitted diseases would also reduce the rate of HIV transmission . Subsequently, the study identified 415 couples in which one partner was HIV positive and one was initially HIV negative and followed them prospectively for up to 30 months . Researchers were not permitted to inform the seronegative partner of the HIV status of the other partner . As a result, 90 of the initially HIV negative partners (21.7%) seroconverted during a follow-up period of 30 months . To allow for research studies in developing countries that are not permitted in the United States appears to make the Third World equivalent to a 'research sweat shop' . Developing nations offer easy access to patients, reduced costs, and less stringent regulations . This appears to create a double standard for medical research that is both ethically and humanly unacceptable, especially when other viable option exist . To allow relativism to seep into the international and national ethical standards will open the door to an idea that condones the possible abuse of those least able to protect themselves . Researchers have an ethical responsibility to uphold the integrity of these ethical standards . Failure to do so today may have a devastating impact on humanity in the future.

Otol Neurotol, 2002 Sep, 23(5), 647 - 52
Expression of epidermal growth factor, tumor necrosis factor-alpha, and interleukin-1alpha in chronic otitis media with or without cholesteatoma; Yetiser S et al.; OBJECTIVE: The object of this study was to compare the expression of epidermal growth factor, interleukin-1alpha, and tumor necrosis factor-alpha in chronic otitis media with or without cholesteatoma . BACKGROUND: It has been reported that cytokines and epidermal growth factor are effective in the bone resorption process in chronic otitis media . Bone resorption can also occur in chronic otitis media without cholesteatoma . However, comparative analysis is lacking . This issue has been investigated in a blind, controlled and prospective analysis . METHOD: The activities of interleukin-1alpha, tumor necrosis factor-alpha, and epidermal growth factor were determined by commercially available enzyme-linked immunosorbent assay kits in tissue biopsy samples from 16 patients without cholesteatoma and from 23 patients with cholesteatoma (cholesteatoma epithelium) . To establish a control group, external auditory canal skin was randomly collected from two groups (21 patients) . The Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis . RESULTS: The levels of interleukin-1alpha, tumor necrosis factor-alpha, and epidermal growth factor in tissue samples from the group with cholesteatoma were significantly greater than those in the group without cholesteatoma and the control group . No correlation was observed with other clinical factors such as age, sex, and antibiotic coverage . CONCLUSION: Higher levels of cytokines in patients with cholesteatoma confirm that the destructive behavior of cholesteatoma is likely mediated by cytokines and epidermal growth factor and is the result of keratinocyte activity . Antibiotic treatment does not affect the level of cytokine concentration in patients with chronic otitis media and cholesteatoma, although the ear discharge subsides and inflammation-related symptoms regress in some cases.

BMC Fam Pract . 2002 Sep 09;3(1):16.
Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing; Coenen S et al.; BACKGROUND: Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs) . Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing . We aimed to determine items of importance for the antibiotic prescribing decision and to make them operational for an intervention trial . METHODS: A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs) . On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment . Factor analysis was used to condense the data . The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test . RESULTS: 59.5% completed the study . Response group characteristics (mean age: 42.8 years; 65.9% men) approximated that of all Flemish GPs . Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' - both medical reasons - and to a lesser extent 'non-medical reasons' (P < 0.001) . Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001) . CONCLUSION: This study quantified, condensed and confirmed the findings of previous focus group research . Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.

Dtsch Med Wochenschr, 2002 Sep 6, 127(36), 1815 - 8
{Endemic celiac sprue and Hodgkin's disease in a 72-year-old patient}; Platen E et al.; HISTORY AND CLINICAL FINDINGS: A 72-year-old man was admitted with diarrhea, loss of weight and anemia . The diarrhea started after antibiotic treatment of a pneumonia and persisted for 6 months at admission . Monoclonal gammopathy was found on external examination . INVESTIGATIONS AND DIAGNOSIS: The work-up yielded iron deficiency anemia, monoclonal gammopathy (IgG kappa) and elevated polyclonal IgA due to Gliadin- and endomysium-antibodies . Duodenal mucosa biopsies showed villous atrophy and increased intraepithelial lymphocytes . Celiac disease was diagnosed . Unexpectedly, mediastinal lymphomas were found and the concomitant diagnosis of Hodgkin's disease was made . TREATMENT AND COURSE: On gluten free diet all symptoms of malabsorption resolved . Therapy for the Hodgkin lymphoma with chemotherapy was initiated . As Bleomycin associated lung disease occurred during therapy, radiotherapy was not administered . A complete remission could be achieved . CONCLUSIONS: The association of celiac disease and malignancy is well known . The pathogenesis is not fully understood, but a correlation between the duration of gluten exposure and the rate of malignancy was found . Thus, the chronic immunologic stimulation might also have contributed to the development of Hodgkin's disease in our patient, which to date has been reported only anecdotally.

J Comp Neurol, 2002 Sep 9, 451(1), 70 - 8
Changes in MAP2 and tyrosinated alpha-tubulin expression in cochlear inner hair cells after amikacin treatment in the rat; Ladrech S et al.; The expression of MAP2 (microtubule-associated protein 2) and of tyrosinated alpha-tubulin was investigated immunocytochemically in the cochleas of normal and amikacin-treated rats . For MAP2, two different antibodies were used: anti-MAP2ab, against the high molecular weight forms, and anti-MAP2abc, additionally against the embryonic form c . In the cochlea of the normal rat, the outer (OHCs) and inner (IHCs) hair cells were labeled for MAP2abc . The labeling was weaker in IHCs than in OHCs . The hair cells were rarely labeled for MAPab . Both OHCs and IHCs were labeled for tyrosinated alpha-tubulin . In the cochlea of the amikacin-treated rat, aggregates of anti-MAP2abc and anti-tyrosinated alpha-tubulin antibodies were seen in the apical region of the IHCs as early as the end of the antibiotic treatment . In rats investigated during the following week, the cell body of most of the surviving IHCs were not labeled for MAP2abc and tyrosinated alpha-tubulin . Then, labeling for these two antibodies reappeared in the surviving IHCs, including their giant stereocilia . Fewer surviving IHCs were labeled for tyrosinated alpha-tubulin than for MAP2abc . The amikacin-poisoned IHCs were rarely labeled for MAP2ab . These results suggest that cochlear hair cells essentially express form c of MAP2 . In the amikacin-damaged cochlea, the apical aggregation of MAP2c and tyrosinated alpha-tubulin within the poisoned IHCs could be implicated in a cell degenerative process . By contrast, the extinction and recovery of MAP2c and tyrosinated alpha-tubulin labeling in the remaining IHCs suggest the occurrence of a limited repair process . A possible role of MAP2 and tubulin in hair cell survival is discussed .

Circulation, 2002 Sep 3, 106(10), 1219 - 23
Effect of treatment for Chlamydia pneumoniae and Helicobacter pylori on markers of inflammation and cardiac events in patients with acute coronary syndromes: South Thames Trial of Antibiotics in Myocardial Infarction and Unstable Angina (STAMINA); Stone AF et al.; BACKGROUND: Infection with Helicobacter pylori and Chlamydia pneumoniae is associated with coronary heart disease . We conducted an intervention study using antibiotics against these bacteria in patients with acute coronary syndromes to determine whether antibiotics reduce inflammatory markers and adverse cardiac events . METHODS AND RESULTS: Patients (n=325) admitted with acute myocardial infarction or unstable angina (acute coronary syndromes) were randomized to receive a 1-week course of 1 of 3 treatment regimens: (1) placebo; (2) amoxicillin (500 mg twice daily), metronidazole (400 mg twice daily), and omeprazole (20 mg twice daily); or (3) azithromycin (500 mg once daily), metronidazole (400 mg twice daily), and omeprazole (20 mg twice daily) . Serum fibrinogen, white cell count, and high-sensitivity C-reactive protein were measured at study entry and at 1, 3, and 12 months during follow-up . Cardiac death and readmission with acute coronary syndrome were considered clinical end points . Patients were followed for 1 year . C-reactive protein levels were reduced (P=0.03) in unstable angina patients receiving amoxicillin, and fibrinogen was reduced in both patient groups receiving antibiotics (P=0.06) . There were 17 cardiac deaths and 71 readmissions with acute coronary syndrome . No difference in frequency or timing of end points was observed between the 2 antibiotic groups . At 12 weeks, there was a 36% reduction in all end points in patients receiving antibiotics compared with placebo (P=0.02) . This reduction persisted during the 1-year follow-up . Neither C pneumoniae nor H pylori antibody status was significantly related to response to treatment . CONCLUSIONS: Antibiotic treatment significantly reduced adverse cardiac events in patients with acute coronary syndromes, but the effect was independent of H pylori or C pneumoniae seropositivity.

Clin Diagn Lab Immunol, 2002 Sep, 9(5), 1061 - 6
Use of egg yolk-derived immunoglobulin as an alternative to antibiotic treatment for control of Helicobacter pylori infection; Shin JH et al.; The present study evaluated the potential use of immunoglobulin prepared from the egg yolk of hens immunized with Helicobacter pylori (immunoglobulin Y {IgY}-Hp) in the treatment of H . pylori infections . The purity of our purified IgY-Hp was 91.3%, with a yield of 9.4 mg of IgY per ml of egg yolk . The titer for IgY-Hp was 16 times higher than that for IgY in egg yolk from nonimmunized hens, and IgY-Hp significantly inhibited the growth and urease activity of H . pylori in vitro . Bacterial adhesion on AGS cells was definitely reduced by preincubation of both H . pylori (10(8) CFU/ml) and 10 mg of IgY-Hp/ml . In Mongolian gerbil models, IgY-Hp decreased H . pylori-induced gastric mucosal injury as determined by the degree of lymphocyte and neutrophil infiltration . Therefore, in this experimental model, H . pylori-associated gastritis could be successfully treated by orally administered IgY-Hp . The immunological activity of IgY-Hp stayed active at 60 degrees C for 10 min, suggesting that pasteurization can be applied to sterilize the product . Fortification of food products with this immunoglobulin would significantly decrease the H . pylori infection . In conclusion, the IgY-Hp obtained from hens immunized by H . pylori could provide a novel alternative approach to treatment of H . pylori infection.

Pediatr Pulmonol, 2002 Sep, 34(3), 237 - 41
Dornase alfa in early cystic fibrosis lung disease; Robinson PJ; Leukocytes that infiltrate cystic fibrosis (CF) sputum as a result of infection have long been known to liberate large amounts of DNA, which increases sputum viscosity and promotes the cycle of chronic lung infection and inflammation that ultimately leads to respiratory failure and death . It was only recently recognized that this vicious cycle begins in infancy, and that architectural damage to CF lungs is detectable even in children with normal pulmonary function tests . Dornase alfa cleaves DNA and improves sputum viscosity in CF . Although its efficacy in reducing the risk of acute infectious exacerbations and improving pulmonary function has been recognized for a decade, there is growing interest in its potential for long-term benefit in young patients with mild lung function abnormalities . The Pulmozyme Early Intervention Trial (PEIT) study demonstrated that dornase alfa reduces the risk of pulmonary exacerbations requiring i.v . antibiotic treatment by 34% and improves forced expiratory flow at 25-75% of forced vital capacity (FEF(25-75)), mid-expiratory flow at 50% of forced vital capacity (MEF), and forced expired volume in 1 sec (FEV(1)) over a 2-year period in CF patients with almost normal lung function . A post hoc subgroup analysis suggests that the magnitude of pulmonary function test (PFT) changes may vary, depending on the initial degree of lung function impairment, but that the reduction in exacerbations appears to be a consistent benefit.These results support the current view that CF patients benefit from intervention early in the course of their lung disease .

Clin Infect Dis, 2002 Sep 15, 35(6), 765 - 8 Epub 2002 Aug 21.
Disappearance of trachoma from Western Nepal; Jha H et al.; We assessed how much of the observed decline in the prevalence of trachoma in a district of Western Nepal was due to an antibiotic treatment program and how much to an underlying secular trend outside of the program . Although antibiotic treatments clearly have an effect at 6 months, we were unable to show that this effect persisted at 12 months; in fact, long-term gains may be due to a secular trend in the area.

Am J Trop Med Hyg, 2002 May, 66(5), 450 - 7
Passive surveillance as an instrument to identify risk factors for fatal Rocky Mountain spotted fever: is there more to learn?
Childs JE, Paddock CD.
National surveillance for Rocky Mountain spotted fever (RMSF) dates from 1920; however, the collection of detailed epidemiologic, clinical, and laboratory data on RMSF by using case report forms began in 1970 . Despite issues with compliance and changes in case definitions, surveillance data have permitted researchers to assess risk factors for fatal RMSF quantitatively . Factors consistently associated with increased risk of death include severity of disease, older age, lack of tick bite, absence of classic symptoms, delay in diagnosis and initiation of appropriate antibiotic treatment, and treatment with chloramphenicol only . In several studies, treatment with a tetracycline has been shown to be protective . The continuation of current passive surveillance activities may allow researchers to refine their estimates of risk but is unlikely to produce novel results . Modified surveillance activities could focus on evaluating the risk for fatal RMSF among special populations, monitoring appropriate antibiotic use, and assessing new diagnostic tests.

Rev Esp Cardiol, 2002 Aug, 55(8), 793 - 800
{Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice}; Gonzalez De Molina M et al.; INTRODUCTION AND OBJECTIVES: The present study was made to investigate the degree of discordance between the recommendations of clinical guidelines and actual practice in the care of patients with infectious endocarditis . MATERIAL AND METHODS: Data was gathered on 34 patients that were admitted to our hospital for native valve infection over a 4-year period . The degree of discordance (%) was obtained by comparing each clinical history with a catalog of 15 specific actions recommended in the clinical guidelines for four consecutive phases: pre-diagnosis, hospital diagnosis, antibiotic treatment, and surgical treatment . A system was constructed, scoring each phase with the greatest detected error (on a severity scale of 0 to 8 points) and adding together the scores for the four phases . RESULTS: The mean degree of discordance was 30.5% (range, 0-66%) . Scores of more than six points were clearly associated with an unfavourable evolution . CONCLUSIONS: The recommendations of clinical guidelines for infectious endocarditis are inadequately followed in practice, which can affect the course of the disease . It is necessary to increase adherence to clinical guidelines in practice, in order to improve the care of patients with this serious disease.

J Pediatr Surg, 2002 Sep, 37(9), 1317 - 20
Laparoscopy in children with complicated appendicitis; Lintula H et al.; BACKGROUND/PURPOSE: Laparoscopic appendectomy is an accepted way of dealing with suspected uncomplicated appendicitis in children . The role of laparoscopy in complicated acute appendicitis is more controversial . The purpose of this trial was to compare laparoscopic appendectomy with open appendectomy in children with complicated appendicitis . METHODS: A total of 102 children with suspected acute appendicitis were selected randomly to undergo either a laparoscopic or an open appendectomy . The outcomes of 25 children with complicated appendicitis, 13 in the laparoscopic group and 12 in the open appendectomy group, were analyzed . Children, their parents, and research nurses were blinded to which procedure had been performed and remained blinded until the control visit 7 days after the operation . All 25 children completed a 30-day follow-up . RESULTS: There were no differences in terms of patients' age, sex, weight, height, and appendiceal histology between the 2 groups . All laparoscopic procedures were completed without conversion . The mean (+/-SD) operating time was 63 (+/-31) minutes in the laparoscopic group and 37 (+/-18) minutes in the open appendectomy group (mean difference 26 minutes, 95% CI 5 to 47 minutes, P =.02) . There were 2 major complications in the laparoscopic group in children with appendiceal masses . One child had an entero-cutaneous fistula of the residual appendiceal tip that needed open reoperation . Another child had a pelvic abscess that resolved with antibiotic treatment . Superficial wound infections were encountered in 2 patients in the open appendectomy group . CONCLUSIONS: Laparoscopic appendectomy is an alternative to open procedure in children with complicated appendicitis . Good surgical judgement is necessary in patients with an established appendiceal abscess .

Med Trop (Mars), 2002, 62(2), 193 - 8
{Treatment of noma}; Thiery G et al.; Noma is a disease specific to developing countries . Early antibiotic treatment can stop disease progression . Surviving patients may present disfigurement with functional and cosmetic sequels . The purpose of this report is to describe treatment of active disease and its sequels . Treatment of defects requires reconstructive surgery . Surgical modalities depend on the extent and location of lesions, available technical facilities and surgeon skill . Various flap techniques can be used ranging from simple flaps and autoplasty to complex procedures involving microsurgery.

JAMA, 2002 Aug 28, 288(8), 996 - 1001
Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis; Safdar N et al.; CONTEXT: The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS) . However, other larger studies have reported a protective effect or no association . OBJECTIVE: To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS . DATA SOURCES: PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7 . Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports . No language restrictions were applied to the search . STUDY SELECTION: Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS . Nine of the 26 identified studies fulfilled these criteria . DATA EXTRACTION: Two authors (N.S . and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria . A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies . DATA SYNTHESIS: The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis . Incomplete reporting of data in individual studies precluded adjustment for severity of illness . CONCLUSION: Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration . A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS.

Nippon Ganka Gakkai Zasshi, 2002 Jul, 106(7), 416 - 9
{Canaliculitis caused by Actinomyces in a case of dry eye with punctal plug occlusion}; Takemura M et al.; BACKGROUND: We report a case of canaliculitis caused by Actinomyces odontolyticus in a case of dry eye with punctal plugs . CASE: A 64-year-old female with Sjogren's syndrome type of dry eye developed lacrimation, congestion in the lower palpebral conjunctiva and corneal epithelial damage in her right eye 30 months after punctal plug occlusion . After removal of the plug from lower punctum in her right eye, white material exuded from the punctum . However, even after the removal of a plug, corneal epithelial keratopathy did not get worse, implying that the granulation tissue formed by the plug completely occluded the canaliculus . Actinomices odontolyticus was cultured from the white material . One week after topical antibiotic treatment, conjunctival congestion and irritation were resolved . CONCLUSION: This report indicates the possibility of canaliculitis as a complication of punctal plug occlusion . Careful observation is necessary after punctal occlusion with punctal plugs.

Ophthalmic Epidemiol, 2002 Oct, 9(4), 263 - 9
Does clinical diagnosis indicate ocular chlamydial infection in areas with a low prevalence of trachoma?
Thein J, Zhao P, Liu H, Xu J, Jha H, Miao Y, Pizzarello L, Tapert L, Schachter J, Mabon M, Osaki-Holm S, Lietman T, Paxton A.
The WHO has initiated a global program to eliminate trachoma . This program includes mass antibiotic administrations to reduce the prevalence of Chlamydia trachomatis, the causative agent in trachoma . DNA amplification tests are the most sensitive methods to diagnose C . trachomatis infection, but are expensive and not typically performed in trachoma-endemic areas . Trachoma programs use clinical examination to determine which communities and which individuals within communities would benefit from antibiotic treatment, so understanding the relationship between clinical activity and chlamydial infection is important . In this study, we determine what percent of individuals with clinically active trachoma are infected with chlamydia in low prevalence communities of China and Nepal (with <10% clinical activity in children), and compare this against a high prevalence community of Nepal (with >30% clinical activity in children) . In the low prevalence areas, only 8% clinically active cases had evidence of chlamydia . In the high prevalence community, 70% of clinically active cases harbored chlamydia . These results imply that clinical activity is less indicative of infection at a lower prevalence . In the context of a trachoma program, both clinically active cases and the community as a whole may stand to benefit less from antibiotic treatment in lower prevalence areas.

Health Commun, 2002, 14(3), 299 - 338
Presenting the problem in pediatric encounters: "symptoms only" versus "candidate diagnosis" presentations; Stivers T; This article examines 2 practices that are used to present children's problems to their pediatricians in acute care encounters . Using the methodology of conversation analysis, this article examines the alternative stances embodied by problem presentations, which offer "symptoms only" versus problem presentations, which also include a "candidate diagnosis." This article suggests that parents who offer only symptoms in their problem presentations are hearable as adopting a stance that they are primarily seeking medical evaluations of their children . By contrast, a parent who includes a candidate diagnosis of the problem is hearable as adopting a stance that he or she is seeking confirmation of the diagnosis and treatment for that illness condition . This communication practice may be treated by physicians as placing pressure on them to prescribe treatment-in particular antibiotic treatment . The implications of this are discussed.

Neurosurgery, 2002 Aug, 51(2), 358 - 61; discussion 361-4
Prospective feasibility study of outpatient stereotactic brain lesion biopsy; Bhardwaj RD et al.; OBJECTIVE: To assess the safety and feasibility of performing computed tomography-guided stereotactic brain lesion biopsy as an outpatient day-surgery procedure . METHODS: In late 1996, a prospective trial of outpatient stereotactic biopsies was initiated . The protocol consists of preadmission education of the patient, computed tomography-guided biopsy with local anesthesia (using a Brown-Roberts-Wells or Cosman-Roberts-Wells frame), postoperative observation in the postanesthetic care unit for 2 hours and in the day surgery unit for 2 hours, and then discharge home 4 hours after the procedure . RESULTS: Seventy-six patients constituted the intent-to-treat group, of whom two were not discharged on the same day (97.4% success rate) . The two patients underwent inpatient admission because one required intravenous antibiotic treatment of a brain abscess and the other had a hard lesion in the brainstem that precluded biopsy needle penetration; admission for further investigation of the lesion was elected . Two patients experienced complications (2.6%), i.e., one small area of intraventricular hemorrhage that produced only a mild headache and one case of mild worsening of preexisting leg weakness, with negative computed tomographic results . CONCLUSION: Discharging patients home after 4 hours of observation after stereotactic biopsies seems to be a safe, well-tolerated practice . In this series, there was no major morbidity and no patient was disadvantaged by participating in this protocol . This approach would be expected to result in health care resource and cost savings, with a potential increase in patient satisfaction because of shorter hospital stays.

Am Fam Physician, 2002 Aug 1, 66(3), 435 - 40
Rosacea: a common, yet commonly overlooked, condition; Blount BW et al.; Rosacea is a common, but often overlooked, skin condition of uncertain etiology that can lead to significant facial disfigurement, ocular complications, and severe emotional distress . The progression of rosacea is variable; however, typical stages include: (1) facial flushing, (2) erythema and/or edema and ocular symptoms, (3) papules and pustules, and (4) rhinophyma . A history of exacerbation by sun exposure, stress, cold weather, hot beverages, alcohol consumption, or certain foods helps determine the diagnosis; the first line of treatment is avoidance of these triggering or exacerbating factors . Most patients respond well to long-term topical antibiotic treatment . Oral or topical retinoid therapy may also be effective . Laser treatment is an option for progressive telangiectasis or rhinophyma . Family physicians should be able to identify and effectively treat the majority of patients with rosacea . Consultation with subspecialists may be required for the management of rhinophyma, ocular complications, or severe disease . (Am Fam Physician 2002;66:442.)

Ned Tijdschr Geneeskd, 2002 Jul 27, 146(30), 1420 - 3
{Pneumonia due to Legionella pneumophila in an immunocompromised child}; van Dijk K et al.; A one-year-and-seven-months-old boy was hospitalised because of fever, cough and general malaise . A diagnosed tonsillitis and pneumonia were treated with intravenous antibiotics . His clinical condition worsened despite antibiotic therapy . After immunologic investigations revealed both a cellular and a humoral immune disorder, a broncho-alveolar lavage was performed . The culture revealed Legionella pneumophila . Antibiotic treatment was then changed to erythromycin in combination with rifampicin, with a good response . Although rarely described in childhood, one should consider L . pneumophila as a possible pathogen in immunocompromised children presenting with pneumonia.

Dermatol Surg, 2002 Aug, 28(8), 768 - 71; discussion 771
Atypical mycobacterial infection following blepharoplasty and full-face skin resurfacing with CO2 laser; Rao J et al.; BACKGROUND: With the popularity of laser skin resurfacing for the correction of photoaging and the improvement of acne scarring, it is important to note complications that may result from this procedure . Infections must be recognized and treated early, as some can result in permanent local destruction and systemic spread to other body sites . OBJECTIVE: To increase the awareness of an unusual infection that may result from laser resurfacing . METHODS: We report the case of a 52-year-old woman who presented with two symmetrical nodules 1 month after full-face skin resurfacing with CO2 laser . These were found to be abscesses caused by Mycobacterium fortuitum infection . RESULTS: The diagnosis was established following surgical debridement and subsequent culture grown from the exudate . Oral antibiotic treatment guided by organism sensitivity resulted in complete clearance of the infection with no recurrence or sequelae after 3 years of follow-up . CONCLUSION: This case demonstrates that atypical mycobacterial infections may arise after laser resurfacing procedures, despite proper technique, sterile instrumentation, and appropriate perioperative medications and postoperative wound care . If diagnosed and treated early, this potentially disastrous complication can be cured with no permanent sequelae.

J Eval Clin Pract, 2002 Aug, 8(3), 341 - 8
Clinical and economic outcomes of pneumonia in children: a longitudinal observational study in an Italian paediatric hospital; Di Ciommo V et al.; RATIONALE, AIMS AND OBJECTIVES: Antibiotic prescription for acute lower respiratory infections (ALRI) in hospitalized children can have a major impact on cure and costs . We performed a longitudinal study to explore the appropriateness of prescriptions, the predictors of therapeutic patterns, and the main outcomes: readmission, length of stay (LOS) and costs . METHODS: Ninety-nine children who were inpatients of a paediatric hospital receiving antibiotic treatment for community acquired ALRI were consecutively enrolled . To calculate the costs of pneumonia treatment, we collected data on clinical presentation and resources consumption . We used multiple regression analysis to identify predictors of LOS and choice of therapy, and one-way ANOVA to evaluate cost differences among treatment groups . RESULTS: Parenteral antibiotics were administered in 64.6% of cases, whereas 35.4% received oral antibiotic therapy by itself (OAT) . Switch therapy (SWT) was performed in 43.4% of cases . The most frequently prescribed antibiotic for parenteral therapy was ceftriaxone (58.3%), and for oral therapy cefprozil (58.1%) . The median LOS was 3 days and the cure rate 99% (95%CI: 97-100%) . SWT and OAT were significantly associated with a shorter LOS . The clinical variables were not significantly associated with SWT or OAT . The average costs per patient in the management of pneumonia were Euro 1435 . SWT or OAT were associated with significant lower costs: Euro 1487 per patient (95%CI: 1395-1580) and Euro 1335 per patient (95%CI: 1233-1437), respectively . CONCLUSIONS: The hospital management of paediatric pneumonia was more influenced by the early discharge policy than by clinical variables without under-cure.

Eur Urol, 2002 Aug, 42(2), 163 - 6
Cost effectiveness model comparing trimethoprim sulfamethoxazole and ciprofloxacin for the treatment of chronic bacterial prostatitis; Kurzer E et al.; OBJECTIVES: Antibiotics are the mainstay for the treatment of men with bacterial prostatitis . Despite numerous treatment strategies involving various types, dosages and duration of antibiotics, no uniform standard has been widely adapted . Moreover, the economic burden of these therapies has been heretofore poorly described . The purpose of this study was to compare the cost effectiveness of various antibiotic treatment regimens for chronic bacterial prostatitis.METHODS: After reviewing the literature, we constructed a model that compared 90 days of double strength trimethoprim-sulfamethoxazole and 14, 28 and 60 days of ciprofloxacin 500 mg . Parameters examined included initial cure rates, relapse rates, total cure rates, pharmaceutical costs, and total cost of treatment . Using a spreadsheet Markov model, we applied cure rates and relapse rates to a hypothetical cohort of 100 men with culture positive chronic bacterial prostatitis . We then calculated cost of medications and total healthcare costs for the various drug regimens.RESULTS: Twice daily ciprofloxacin @ 500 mg for 28 days proved to be the most cost effective treatment for chronic bacterial prostatitis . Yet, after sensitivity analysis, only twice daily ciprofloxacin @ 500 mg for 60 days demonstrated consistent benefit over trimethoprim-sulfamethoxazole but at a substantially increased cost.CONCLUSIONS: Our model implies that ciprofloxacin 500 mg twice daily for 28 days appears to be the most cost effective treatment for chronic bacterial prostatitis . Given the limitations of this type of modeling, long term, prospective, comparative trials will provide the most definitive method of evaluating optimal therapy for chronic bacterial prostatitis.

Scand J Infect Dis, 2002, 34(6), 421 - 5
5-y Follow-up study of patients with neuroborreliosis; Berglund J et al.; The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics . A 1-y prospective population-based survey of Lyme borreliosis was conducted in southern Sweden between 1992 and 1993 . A total of 349 identified cases with suspected neuroborreliosis were followed up 5 y later . Medical records were reviewed and all participants filled in a questionnaire . Of those patients classified with definite neuroborreliosis, 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment . Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months . Residual neurological symptoms, such as facial palsy, concentration disorder, paresthesia and/or neuropathy, were reported by 28/114 patients . No significant differences between different antibiotic treatments were observed in terms of the occurrence of sequelae . To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 y post-treatment . However, the clinical outcome of treated neuroborreliosis is favorable as only 14/114 (12%) patients had sequelae that influenced their daily activities post-treatment . Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

Arch Intern Med, 2002 Aug 12-26, 162(15), 1753 - 60
Withholding antibiotic treatment in pneumonia patients with dementia: a quantitative observational study; van der Steen JT et al.; BACKGROUND: Pneumonia is a life-threatening disease in nursing home patients with dementia . Physicians and families face choices about whether to withhold antibiotics when patients are expected to die soon or when treatment may be burdensome . However, little information exists on what factors influence this complex decision-making process . OBJECTIVE: To identify factors associated with decisions on whether to withhold curative antibiotic treatment in patients with dementia who have pneumonia . METHODS: We performed an observational cohort study with 3-month monitoring for cure and death . Patients with pneumonia (N = 706) were enrolled in nursing home units for patients with dementia from all over the Netherlands (61 nursing homes) . Characteristics of patients, physicians, and facilities were related to the outcome of withholding antibiotic treatment . RESULTS: In 23% of the patients, antibiotic treatment was withheld . The other patients received antibiotics with palliative (8%) or curative (69%) intent . Compared with the patients who received antibiotics with curative intent, patients in whom antibiotic treatment was withheld had more severe dementia, had more severe pneumonia, had lower food and fluid intake, and were more often dehydrated . In addition, withholding antibiotics occurred more often in the summer and in patients with an initial episode of pneumonia . Characteristics of facilities and physicians were unrelated to the decision . However, considerable variation occurred in how patient age, aspiration, and history of pneumonia were related to decision making by individual physicians . CONCLUSIONS: In the Netherlands, antibiotic treatment is commonly withheld in pneumonia patients with severe dementia who are especially frail . Understanding the circumstances in which this occurs can illuminate the international discussion of appropriate dementia care.

Health Policy, 2002 Oct, 62(1), 1 - 13
The effect of drug co-payment policy on the purchase of prescription drugs for children with infections in the community; Reuveni H et al.; A cross-sectional study was conducted to investigate the influence of the co-payment policy in a community setting on the purchase of prescription medications for children with acute infections . Data for all purchased medications prescribed for children with an acute infectious disease were gathered from a pediatric health care center over a 6-week period . Parents of the sick children and controls were interviewed by telephone, using a short sociodemographic questionnaire, and were asked to state their reasons for not purchasing (either partially or completely) necessary medications, primarily antibiotics . Of the 779 children who received a prescription for antibiotics during the 6-week period, 162 (20.7%) failed to take the complete course of antibiotic treatment . One hundred and one parents of these children (62.3%) were interviewed, of whom 30 (29.7%) claimed that the main reason for not buying the full course of antibiotic medication was the cost . This group is characterized by low income, overcrowded housing conditions and a large quantity of prescription medications . The cost of prescribed medication under the co-payment policy is a serious barrier to the purchase of prescribed medication for children with acute infections in the primary care setting . The policy has a particularly deleterious effect in under-privileged populations and is in contradiction with the proclaimed principles of justice and equality underlying the obligatory Israeli National Israeli Health Insurance Law and similar laws in other western countries.

J Am Board Fam Pract, 2002 Jul-Aug, 15(4), 277 - 84
Lyme disease knowledge, beliefs, and practices of New Hampshire primary care physicians; Magri JM et al.; BACKGROUND: Lyme disease is the most commonly reported vectorborne illness in the United States and is endemic in many counties in the Northeast, including counties in New Hampshire . Previous studies conducted elsewhere on Lyme disease have indicated substantial differences between physician practices and published consensus guidelines for diagnosis and treatment . METHODS: During 1999, we mailed a 21-item questionnaire to 600 randomly selected family practice physicians, internists, and pediatricians in New Hampshire . RESULTS: Respondents answered a median of 10 (76.9%) of 13 knowledge items correctly . Most physicians (73.6%) underestimated the incidence of erythema migrans among Lyme disease patients, and 41.2% would either test or offer treatment to an asymptomatic patient with deer-tick bite . When surveyed, most respondents (72.4%) planned to recommend Lyme disease vaccine to high-risk persons . Approximately one half (44.8%) reported giving empiric antibiotic treatment of Lyme disease solely because of patient concern . CONCLUSIONS: New Hampshire primary care physicians indicated good knowledge about Lyme disease . Lack of awareness about Lyme disease diagnostic criteria, however, could contribute to misdiagnosis through overreliance on laboratory testing . Lyme disease vaccine appeared to be well accepted by physicians, although the vaccine has since been withdrawn from the US market . Both inappropriate management of tick bite and empiric treatment of unsubstantiated Lyme disease diagnoses were common.

J Pediatr Surg, 2002 Aug, 37(8), 1183 - 7
Multiple intrahepatic biliary cysts in children with biliary atresia; Bu LN et al.; PURPOSE: The aim of this study was to investigate the incidence, clinical course, and outcome of multiple intrahepatic biliary cysts in patients with biliary atresia . METHODS: From 1992 to 2000, 154 patients with biliary atresia were examined for intrahepatic cysts . They were followed and examined routinely using abdominal ultrasonography . RESULTS: Twenty-three patients had single intrahepatic cysts, and 16 patients had multiple cysts . The incidence of intrahepatic cysts in these patients were 25.3% (39 of 154) for all kinds of cysts and 10.4% (16 of 154) for multiple intrahepatic cysts . Of the 16 patients with multiple cysts, 13 (81.3%) had jaundice, and 15 (93.8%) had a history of cholangitis before cysts were detected . Image studies showed multiple discrete ovoid or round intrahepatic biliary cysts with various sizes along the biliary trees . The cysts decreased in size or number in 7 patients after antibiotic treatment and disappeared in only one patient . The mortality rate was higher in patients with multiple cysts than in those with single cysts (P =.037) . CONCLUSIONS: Multiple intrahepatic biliary cysts are a common complication in patients with biliary atresia and suggests a poor prognosis . Prolonged parenteral antibiotics treatment should be administered when signs of biliary infection appear .

Thorax, 2002 Aug, 57(8), 672 - 6
Chlamydia pneumoniae and chronic bronchitis: association with severity and bacterial clearance following treatment; Blasi F et al.; BACKGROUND: A study was undertaken to evaluate Chlamydia pneumoniae chronic infection, other respiratory infections, and functional impairment in patients with chronic bronchitis (stage 1) and to examine chronic C pneumoniae infection, rate of acute exacerbations of chronic bronchitis, and rate of C pneumoniae eradication following antibiotic treatment (stage 2) . METHODS: In the stage 1 study respiratory specimens from 42 patients with steady state chronic bronchitis were analysed for Gram staining, sputum culture, and C pneumoniae DNA detection by nested touchdown polymerase chain reaction (PCR) . On the basis of the results of stage 1, a second population of 141 consecutive patients with steady state mild to moderate chronic bronchitis (FEV(1) >or=50% predicted) was studied . On admission, at regular intervals, and at exacerbation all patients underwent serological testing for C pneumoniae (microimmunofluorescence) and a nested touchdown PCR to detect C pneumoniae DNA was performed on peripheral blood mononuclear cells (PBMCs) . Patients were assessed over a 12 month period . Information regarding the previous 12 months was taken from medical records . RESULTS: Chronic colonisation of the sputum with C pneumoniae was significantly associated with lower FEV(1) and greater airway bacterial colonisation . On admission to the stage 2 study, 80 patients were PCR negative and 61 were PCR positive . Over the 2 years a mean (SD) of 1.43 (1.32) acute exacerbations occurred in PCR negative patients and 2.03 (1.21) in PCR positive patients (p<0.01) . During the 12 month follow up period 34 PCR positive patients had acute exacerbations and were treated with azithromycin for 6 weeks . Serological evidence of acute C pneumoniae reinfection/reactivation was found in two of the 34 patients . The rate of C pneumoniae DNA clearance from blood following treatment was 29% at follow up . CONCLUSION: Chronic colonisation with C pneumoniae is associated with a higher rate of exacerbations of chronic bronchitis . Long term treatment is required to obtain clearance of the organism from the blood.

Klin Med (Mosk), 2002, 80(6), 64 - 6
{The onset of chronic Lyme-borreliosis after the cure of tick-borne rickettsia infection in simultaneous infection}; Mediannikov OIu et al.; A case of a male patient with chronic Lyme borreliosis running with marked neurological symptoms (Garin-Bujardoux-Bannwarth syndrome) is reported . Two years before the disease manifestation the patient was infected by the tick with both borrelia and Rickettsia sibirica . The latter infection provoked an acute fever in tick-borne rickettsiosis immediately after the tick's bite . This masked development of Lyme borreliosis which manifested only 5 months later as a neurological disease . It is thought necessary to propose a rational scheme of antibiotic treatment of patients with tick-transmissible diseases.

Cochrane Database Syst Rev . 2002;(3):CD000247.
Antibiotics for the common cold; Arroll B et al.; BACKGROUND: The common cold is considered to be caused by viruses and it has long been believed that antibiotics have no role in treating this condition . In many countries doctors will often prescribe antibiotics for the common cold in the belief that they may prevent secondary bacterial infection and in some cases to respond to patient demand . There is also increasing concern over the resistance of common bacteria to commonly used antibiotics . A crucial step in reducing the use of antibiotics for the common cold is to examine the evidence to see if there is any benefit or if there is benefit for some subgroups or symptom constellations . OBJECTIVES: (1) To determine the efficacy of antibiotics in comparison with placebo in the treatment of acute upper respiratory tract infections (common colds) in terms of the proportion of patients in whom the clinical outcome was considered to be a reduction in general symptoms and specific nasopharyngeal symptoms . (2) To determine whether there are significant adverse outcomes associated with antibiotic therapy for patients with a clinical diagnosis of acute upper respiratory tract infection . SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, the Family Medicine Database, and reference lists of articles, and we contacted principal investigators . The most recent search was in May 2001 SELECTION CRITERIA: Randomised trials comparing any antibiotic therapy with placebo in acute upper respiratory tract infections with less than 7 days of symptoms DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data . MAIN RESULTS: All analyses used fixed effects unless otherwise stated Main results: Nine trials involving 2249 (2157 analysed) people aged between two months and 79 years (and adults with no upper age limit) years were included . The overall quality of the included trials was variable . People receiving antibiotics did not do better in terms of lack of cure or persistence of symptoms than those on placebo (odds ratio 0.8, 95% confidence interval (95% CI) 0.59 to 1.08) . Only one study Taylor et al (1977) specifically reported persistence of clear rhinitis with a small benefit to those on antibiotics . Two studies found a significant benefit for antibiotics compared with placebo for runny nose (clear) odds ratio 0.42 (0.22-0.78) . Two studies also found a significant benefit in patients with sore throat odds ratio 0.27 95% CI (0.10-0.74) . Only one study reported work time lost with 22% of those on antibiotic treatment and 25% of those on placebo but this was not significant . Adult patients treated with antibiotics had a significant increase in adverse effects (odds ratio 3.6 95% CI 2.21 to 5.89) while there was no significant increase in children odds ratio 0.90 95% CI (0.44-1.82) . REVIEWER'S CONCLUSIONS: Reviewers' conclusions: There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics to warrant their routine use in children or adults and there is a significant increase in adverse effects associated with antibiotic use in adult patients.

Pharmacol Res, 2002 May, 45(5), 369 - 74
Exploring the variability in antibiotic prescribing profiles among paediatricians from two different areas of Italy; Cucinotta G et al.; We carried out a multicentre community-based study in order to describe the antibiotic therapeutic approach of paediatricians from two different areas of Italy in the treatment of respiratory tract infection (RTIs), and to assess which factors are involved in a possible variability of prescribing habits . Forty paediatricians participated in the study between October 1998 and April 1999 . They had to complete a questionnaire for each therapeutic intervention resulting in an antibiotic prescription . A logistic regression model was used to identify possible predictors in choosing parenteral antibiotics for the treatment of RTIs . In 2 975 questionnaires of antibiotic treatment, RTIs represented 90.2% of the total antibiotics used . Upper respiratory tract infections were the most commonly treated diagnostic group (59.6%), followed by lower respiratory tract infections (20.4%), and middle ear infections (19.8%) . Statistically significant differences between northern and southern Italy were reported in the antibiotic prescription profile and the duration of the therapy . Another marked difference was reported in the frequency of laboratory analysis requests . The logistic regression model indicated that the use of parenteral antibiotics appears significantly related to the type of infections {lower RTIs: (OR: 3.99; 95% CI: 2.49-6.37)}, the geographic location {northern Italy: (OR: 0.20; 95% CI: 0.20-0.39)}, and the presence of concurrent diseases (OR: 3.21; 95% CI: 1.46-7.02) . The lack of adherence to clinical guidelines and the marked variability of antibiotic prescription rates between different areas of the country appear to be related to factors other than bacterial resistance, and highlight the importance of carrying out educational programmes targeted at the national level for improving the antibiotic prescription habits for the treatment of RTIs.

Curr Opin Rheumatol, 2002 Jul, 14(4), 383 - 7
Lyme arthritis and post-Lyme disease syndrome; Weinstein A et al.; In the United States, intermittent or chronic mono- or oligoarthritis, particularly affecting the knee, is the most common manifestation of late Lyme disease (LD) . Lyme arthritis (LA) can usually be prevented by early treatment of acute LD . However, the erythema migrans rash may go undetected in children and in the dark skin of African Americans, leading to delayed treatment and a relatively increased incidence in LA . Virtually all untreated patients with LA have high levels of serum immunoglobulin G antibodies, and sometimes low levels of immunoglobulin M antibodies, to Borrelia burgdorferi (Bb) by ELISA and Western blot . These responses may persist for many years after antibiotic treatment, and therefore, serologic results do not accurately distinguish between active or past infection . Most patients with LA respond well to standard courses of antibiotic treatment, but a small percentage have persistent knee synovitis, in some cases possibly related to the triggering of intrasynovial autoimmunity . Other patients develop a syndrome of diffuse arthralgia, myalgia, fatigue, and subjective cognitive difficulty during or soon after LD, which persists despite antibiotic treatment . Patients with this post-treatment, post-LD syndrome were recently studied in a placebo-controlled double-blind antibiotic trial . There was no evidence of Borrelial infection in these patients by culture or detection of Bb DNA in blood or spinal fluid . Furthermore, there was no difference in responsiveness of these patients to a 3-month course of antibiotic compared with placebo treatment . Thus, LA caused by active Bb infection, post-treatment LA with persistent knee synovitis and post-LD syndrome are distinct and distinguishable clinical entities.

Chest, 2002 Jul, 122(1), 262 - 8
Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia; Iregui M et al.; STUDY OBJECTIVES: To determine the influence of initially delayed appropriate antibiotic treatment (IDAAT) on the outcomes of patients with ventilator-associated pneumonia (VAP) . SETTING: Medical ICU of Barnes-Jewish Hospital, St . Louis, a university-affiliated urban teaching hospital . PATIENTS: One hundred seven consecutive patients receiving mechanical ventilation and antibiotic treatment for VAP . INTERVENTIONS: Prospective patient surveillance and data collection . MEASUREMENTS AND RESULTS: All 107 patients eventually received treatment with an antibiotic regimen that was shown in vitro to be active against the bacterial pathogens isolated from their respiratory secretions . Thirty-three patients (30.8%) received antibiotic treatment that was delayed for >or= 24 h after initially meeting diagnostic criteria for VAP . These patients were classified as receiving IDAAT . The most common reason for the administration of IDAAT was a delay in writing the antibiotic orders (n = 25; 75.8%) . The mean time (+/- SD) interval from initially meeting the diagnostic criteria for VAP until the administration of antibiotic treatment was 28.6 +/- 5.8 h among patients classified as receiving IDAAT, compared to 12.5 +/- 4.2 h for all other patients (p < 0.001) . Forty-four patients (41.1%) with VAP died during their hospitalization . Increasing APACHE (acute physiology and chronic health evaluation) II scores (adjusted odds ratio, 1.13; 95% confidence interval, 1.09 to 1.18; p < 0.001), presence of malignancy (adjusted odds ratio, 3.20; 95% confidence interval, 1.79 to 5.71; p = 0.044), and the administration of IDAAT (adjusted odds ratio, 7.68; 95% confidence interval, 4.50 to 13.09; p < 0.001) were identified as risk factors independently associated with hospital mortality by logistic regression analysis . CONCLUSION: These data suggest that patients classified as receiving IDAAT are at greater risk for hospital mortality . Clinicians should avoid delaying the administration of appropriate antibiotic treatment to patients with VAP in order to minimize their risk of mortality.

Proteomics, 2002 Jun, 2(6), 683 - 9
Bronchoalveolar lavage protein patterns in children with malignancies, immunosuppression, fever and pulmonary infiltrates; Neumann M et al.; Severe respiratory infections are a major cause of morbidity and mortality in children receiving immunosuppressive therapy for malignancies . The goal of this study was to assess the major changes in the protein patterns in these children . Bronchoalveolar lavage (BAL) fluids of seven control children and of ten children with malignancies and fever not responding to broad spectrum antibiotic treatment was separated by horizontal two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis in the isoelectric point range 3-9 . We observed a large increase of alpha(1)-antitrypsin (p = 0.0004) and decreases of the immunoglobulin (Ig) binding factor, transthyretin and cystatin S . Significant changes occurred also in the small acidic proteins . The relative abundance of the IgG heavy and light chains may hinder the separation and identification of many minor protein spots located in the basic area of the gel, suggesting that their removal during sample preparation may be warranted . This study demonstrated significant alterations in BAL fluid proteome in immunosuppressed children with persistent fever and pulmonary infiltrates . Future target regions of interest were identified . Sample prefractionation and the selection of suitable narrow isoelectric point ranges will be necessary for optimized detection and separating conditions.

Eur J Clin Microbiol Infect Dis, 2002 Jun, 21(6), 480 - 2 Epub 2002 Jun 11.
First definite case of aortic valve endocarditis due to Moraxella phenylpyruvica; Tripodi MF et al.; Described here is the first definite case of endocarditis due to Moraxella phenylpyruvica, which occurred in a 50-year-old male with a bicuspid aortic valve . The diagnosis was delayed because of the confounding positivity of the Widal and Wright tests . The patient was cured with surgical valve replacement and antibiotic treatment.

Commun Dis Public Health, 2001 Dec, 4(4), 278 - 81
Investigation of postanginal sepsis and Lemierre's syndrome in the South West Peninsula; Jones JW et al.; We describe a retrospective case series of postanginal sepsis and Lemierre's syndrome (LS) identified from laboratory records of Fusobacterium necrophorum isolates and from clinical case note review . Some patients presented with sore throat, tonsillitis, quinsy or a septicaemic illness, whereas others presented with symptoms related to metastatic septic lesions with later recognition of the significance of the preceding sore throat . Patients with otitis media and mastoiditis are included in the study . The incidence of postanginal sepsis and LS appears to have increased over the study period (1994-99) . The population of patients who had received antibiotics pre-admission has decreased in recent years . Attention is drawn to features which may assist in differentiating this condition from simple viral sore throats not requiring antibiotic therapy . A prospective study of the incidence of this rare but life-threatening condition mainly affecting young people is required in view of the more restricted use of antibiotic treatment for sore throat now recommended.

Przegl Lek, 2002, 59 Suppl 1, 43 - 5
{Reliability of polymorphonuclear elastase for the diagnosis of neonatal sepsis}; Wojsyk-Banaszak I et al.; Infections are a major problem in neonatal intensive care units throughout the world, and early diagnosis and therapy would certainly reduce associated morbidity and mortality as well as decrease unnecessary antibiotic treatment . OBJECTIVES: To evaluate the usefulness of polymorphonuclear elastase (PMN-E) serum concentration as an early indicator of neonatal sepsis in comparison with routinely used infection markers . METHODS: PMN-E was measured in 74 newborns with suspicion of systemic bacterial infection treated in a tertiary intensive care unit . The measurements were performed with commercially available enzyme immunoassay (Milenia) . RESULTS: Mean PMN-E value in non-infected newborns was 38.85 ng/ml, and for infected 184.12 ng/ml (p < 0.05) (t-student test) . The sensitivity to the diagnosis of culture--proven bacterial systemic infection was 76% for PMN-E, 60% for C-reactive protein, 59% for the immature to total neutrophil ratio and 56% for the total white blood cell count . The corresponding specificity amounted to 81%, 86%, 100% and 80% respectively . CONCLUSION: Serum PMN-E level determination yields diagnostic advantages in comparison with infection markers routinely used in sepsis screen and may serve as a valuable early indicator of neonatal systemic bacterial infection.

Radiol Med (Torino), 2002 Apr, 103(4), 378 - 83
Interventional treatment of sialoliths in main salivary glands; Salerno S et al.; PURPOSE: The aim of our study was to demonstrate the effectiveness of interventional radiology in the treatment of sialolithiasis, as the first-choice treatment for the removal of stones located in the middle and proximal tracts of the main salivary ducts, and to assess its limitations and contraindications . MATERIAL AND METHODS: Between February 1998 and May 2001 eleven interventional removals of sialoliths were performed for recurrent obstruction of the main salivary duct associated with chronic sialadenitis . Patients were selected on the basis of a preliminary sialogram, designed to determine the location and size of the stone . Exclusion criteria were location of the stone in the gland hilum or intraglandular stone, maximum stone diameter >20% of the duct calibre, signs of adherence of the stone to the duct wall . Stone removal, performed after obtaining informed consent, involved administering antibiotic therapy and local anaesthesia, and dilatating the duct ostium to enable introduction of the basket catheter . The basket was then advanced along the duct under fluoroscopic guidance and suitably manoeuvred so as to capture and extract the stone . On completing the procedure a sialogram was taken to ensure the complete patency of the duct . Patients were prescribed a short course of antibiotics and were followed up at 1, 3 and 6 months . RESULTS: In 10/11 patients the stone was located in Wharton's duct and in 1/11 in Stensen's duct . Removal of the calculus was successful in 10/11 patients; in 2 of these it was necessary to reintroduce the basket after extraction of the stone, in order to eliminate small stone fragments and salivary sand; in 1 patient a preliminary balloon-catheter sialoplasty was performed prior to the procedure to dilatate a distal stenosis caused by chronic sialadenitis; in 3 patients it was necessary to make a small incision in the orifice to introduce the dilator . Removal of the sialolith was unsuccessful in 1/11 of the patients treated, as it proved impossible to capture the calculus, even after repeated attempts . 8/11 patients reported pain during the procedure and swelling in the gland region immediately after the procedure, which resolved spontaneously within 24-48 hours . 9/11 patients remained asymptomatic in the follow-up; only 1/11 patients experienced a recurrence of sialadenitis after a short time, with pus secretion, which resolved with antibiotic treatment . CONCLUSIONS: The interventional removal of sialoliths in the salivary glands is an effective alternative to the conventional treatment of obstructive diseases of the glandular ducts.

J Ultrasound Med, 2002 Jul, 21(7), 731 - 8
Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy; Lee BC et al.; OBJECTIVE: For treatment of suspected pelvic abscesses, the use of the trocar technique avoids many of the technical challenges of the Seldinger method . The purpose of this study was to evaluate the effectiveness and safety of sonographically guided transvaginal aspiration or drainage with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment . METHODS: We retrospectively reviewed 22 patients with suspected pelvic abscesses refractory to antibiotic therapy who underwent single-step transvaginal pelvic aspiration or drainage between 1995 and 2000 . RESULTS: Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients . Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures . Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days . Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate . No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures . CONCLUSIONS: Transvaginal ultrasonographically guided aspiration or catheter placement with the trocar technique is a safe and effective treatment for suspected pelvic abscesses refractory to antibiotic therapy.

BMJ . 2002 Jul 6;325(7354):22; discussion 22.
Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial; Little P et al.; OBJECTIVES: To identify which children with acute otitis media are at risk of poor outcome and to assess benefit from antibiotics in these children . DESIGN: Secondary analysis of randomised controlled trial cohort . SETTING: Primary care . PARTICIPANTS: 315 children aged 6 months to 10 years . INTERVENTION: Immediate or delayed (taken after 72 hours if necessary) antibiotics . MAIN OUTCOME MEASURE: Predictors of short term outcome: an episode of distress or night disturbance three days after child saw doctor . RESULTS: Distress by day three was more likely in children with high temperature (adjusted odds ratio 4.5, 95% confidence interval 2.3 to 9.0), vomiting (2.6,1.3 to 5.0), and cough (2.0, 1.1 to 3.8) on day one . Night disturbance by day three was more likely with high temperature 2.4 (1.2 to 4.8), vomiting (2.1,1.1 to 4.0), cough (2.3,1.3 to 4.2), and ear discharge (2.1, 1.2 to 3.9) . Among the children with high temperature or vomiting, distress by day three was less likely with immediate antibiotics (32% for immediate v 53% for delayed, chi2=4.0; P=0.045, number needed to treat 5) as was night disturbance (26% v 59%, chi2=9.3; P=0.002; number needed to treat 3) . In children without higher temperature or vomiting, immediate antibiotics made little difference to distress by day three (15% v 19%, chi2=0.74; P=0.39) or night disturbance (20% v 27%, chi2=1.6; P=0.20) . Addition of cough did not significantly improve prediction of benefit . CONCLUSION: In children with otitis media but without fever and vomiting antibiotic treatment has little benefit and a poor outcome is unlikely.

Infez Med, 2001 Sep, 9(3), 158 - 62
{Complications of mediterranean spotted fever}; Bellissima P et al.; Mediterranean spotted fever is an infectious disease due to Rickettsia conori transmitted to man by the dog tick Rhipicephalus sanguineus . The review of a consecutive series of 525 cases, admitted to Caltagirone hospital in the last 20 years, permits the classic clinical picture to be identified by fever, maculopapular eruption and tache noire, and any complications to be visualized . Usually the course of the disease is good, but 12.7% of our cases reported complications such as renal failure, myocarditis, pneumonia, encephalitis, anicteric hepatitis, gastrointestinal bleeding, anaemia and impaired glucose tolerance . The development of a systemic vasculite is the main pathogenetic factor in the origin of systemic complications . Early diagnosis and specific antibiotic treatment may reduce the risk of complications.

Curr Urol Rep, 2002 Apr, 3(2), 107 - 14
Vesicoureteral reflux: a new treatment algorithm; Stenberg A et al.; Vesicoureteral reflux (VUR) affects about 1% of all children and carries an increased risk of pyelonephritis and long-term renal impairment . There are several approaches to the treatment of VUR: antibiotic prophylaxis (conservative treatment), open surgery, and endoscopic treatment . For many patients, endoscopic treatment cures VUR with a single procedure, eliminating the need for long-term antibiotic treatment and avoiding the trauma of a major surgical procedure . The choice of material for endoscopic treatment is of key importance, and, until recently, all available materials were associated with concerns regarding safety and efficacy . Emerging data demonstrate that dextranomer/hyaluronic acid (Dx/HA) copolymer has good long-term safety and efficacy in treating VUR . A new treatment algorithm is, therefore, proposed, recommending that most children with persistent VUR (longer than 1 year) be offered endoscopic treatment with Dx/HA copolymer as an alternative to prolonged antibiotic prophylaxis or open surgery.

Infez Med, 2001 Mar, 9(1), 7 - 12
{Outpatient parenteral antibiotic treatment: the Italian model}; Esposito S; Though constrained by the lack of standard criteria for patient selection and well defined therapeutic protocols, the Italian model of OPAT is characterized by the home treatment of infections also of moderate severity, chiefly of the lower respiratory tract by means of broad spectrum antibiotics (chiefly beta-lactams) administered intramuscularly . The selection of patient for OPAT remains an individual decision of GPs based on the severity of infection, concomitant diseases, age of the patient, reliability of patients and family, environ- mental and social factors . Such a model has gained broad consensus over the years from patients for different cultural reasons: first, the willingness of patients to participate in the OPAT programmes, second, the concept that home is better than hospital even when you are ill and, third, the fact that parenteral drugs are perceived as more effective than oral ones, probably in contrast with the culture and traditions of other countries (especially northern Europe) where hospitals are still considered the only proper site of care and intramuscular administration is regarded as almost unnatural . No private or insurance reimbursement based OPAT structure exists up to now in Italy or is go . ing to be developed . The main problems in Italy now seems to be: -to define clear protocols and easy criteria for selection of patients enable to OPAT, -to improve what existing by creating and/or qualifying new professionals involved with in- and outpatients (OPAT, early discharge,medical care for special populations.).

Acta Orthop Scand, 2002 Apr, 73(2), 144 - 50
Progressive surgical release of a posttraumatic stiff elbow . Technique and outcome after 2-18 years in 46 patients; Marti RK et al.; We treated 46 consecutive patients (47 elbows) suffering from posttraumatic contracture of the elbow joint with operative release . A lateral approach was used to perform a capsulectomy after release of the extensor muscles in 23 elbows . An additional medial approach was used to excise ulnar adhesions and perform a more extensive capsulectomy and an ulnar nerve neurolysis in 24 elbows . Postoperative rehabilitation consisted of immediate passive range-of-motion exercises . The results were assessed after average 10 (2-18) years . Before surgery, the mean active arc of motion was 45 (SD 36) degrees, which improved to 99 (SD 34) degrees after release . 7 patients had transient ulnar paresthesia, 4 recurrent stiffness, which did not become worse after surgery, 1 was reoperated on and 2 developed a postoperative infection, which responded to antibiotic treatment after a few months . No patient suffered from joint instability, or an increase in pain . 44 patients were satisfied with the result at the latest follow-up . We found similar improvement in both treatment groups.

Ann Thorac Surg, 2002 Jun, 73(6), 1808 - 12
Partial replacement of the tricuspid valve by mitral homografts in acute endocarditis; Couetil JP et al.; BACKGROUND: Seven patients with acute tricuspid endocarditis underwent partial replacement of the tricuspid valve using mitral homograft tissue . Valve function was evaluated at midterm . METHODS: Operative indications were uncontrolled sepsis in all cases associated with heart failure symptoms in 3 patients and septic pulmonary emboli in 2 patients . These patients were referred to our institution after a course of antibiotic treatment ranging from 7 to 12 weeks . Lesions found at the level of the anterior leaflet of the tricuspid valve were vegetations and rupture of more than half of the marginal cords in all patients . Vegetations were also found on the posterior leaflet in 5 patients . In all instances the septal leaflet was free of lesions . The aortic valve was involved in 4 patients and the pulmonary valve in 1 patient . All patients underwent resection of the anterior and posterior leaflets of the tricuspid valve with their corresponding papillary muscles leaving the septal leaflet in place . Replacement of the tricuspid valve was performed through a right longitudinal atrial access, using the anterior leaflet of a mitral homograft alone in 3 patients and the anterior leaflet with part of posterior leaflet in 4 patients . Associated procedures included aortic valve replacement by a homograft (n = 4) and pulmonary valve reconstruction (n = 1) . RESULTS: No hospital deaths are reported . One late death, at 16 months, is reported after reoperation due to recurrent aortic valve endocarditis . At midterm (mean follow-up, 30 months) patients had excellent functional status and normal valvular function during echocardiographic studies . CONCLUSIONS: We conclude that when the degree of tricuspid valve destruction prevents repair, partial homograft replacement can be used as an extension of the already existing reconstructive techniques, with excellent functional results.

Cochrane Database Syst Rev . 2002;(2):CD003038.
Beta-lactam versus beta-lactam-aminoglycoside combination therapy in cancer patients with neutropaenia; Paul M et al.; BACKGROUND: Chemotherapy treated cancer patients are prone to neutropaenia and life-threatening infections . Early, empirical antibiotic treatment is therefore administered routinely to febrile neutropaenic patients . Currently, either beta-lactam-aminoglycoside combination treatment or beta-lactam monotherapy are recommended . OBJECTIVES: We compared beta-lactam monotherapy versus beta-lactam-aminoglycoside combination therapy for cancer patients with fever and neutroepaenia . SEARCH STRATEGY: Cochrane Library (Issue 4,2001), the Cochrane Cancer Network Register of trials (July 2000), EMBASE (January 1980-2000), MEDLINE (1966-8/2001), and ICAAC conference proceedings (1995 onwards) . We scanned references of all included studies, pertinent reviews, and contacted the first author of each included trial and the pharmaceutical companies . SELECTION CRITERIA: Randomised controlled trials comparing any beta-lactam antibiotic monotherapy to any combination of a beta-lactam and an aminoglycoside antibiotic, for the initial, empirical treatment of febrile neutropaenic cancer patients . DATA COLLECTION AND ANALYSIS: Data concerning mortality, treatment failure (including treatment modifications), superinfections, adverse effects and study quality measures were extracted independently by two reviewers . Relative risks with their 95% confidence intervals (CI) were estimated . Outcomes were extracted by intention-to-treat analysis whenever possible . MAIN RESULTS: Forty-six trials and 7642 patients were included . All cause mortality was the primary outcome assessed . For all mortality comparisons, no significant difference between monotherapy and combination therapy was seen, relative risk 0.85 (95% CI 0.72-1.02) for all studies combined . Treatment failure was the outcome reported in all included trials . No significant difference between study groups was shown for studies comparing the same beta-lactam, relative risk 1.12 (95% CI 0.96-1.29) . A significant advantage to monotherapy was observed for studies comparing different beta-lactams, relative risk 0.86 (95% CI 0.80-0.93) . Bacterial and fungal superinfections developed with similar frequencies in the monotherapy and combination treatment groups . Adverse events were significantly more common in the combination treatment group, relative risk 0.83, (95% CI 0.72-0.97) . These included events associated with significant morbidity, primarily renal toxicity . Results were consistent for subgroup and sensitivity analyses . REVIEWER'S CONCLUSIONS: We have shown an advantage to broad-spectrum beta-lactam monotherapy over beta-lactam-aminoglycoside combination therapy for febrile neutropaenia . This advantage comprises of 1) a similar, if not better, survival, 2) a significantly lower treatment failure rate, 3) comparable probability for secondary infections and, 4) most importantly, a lower rate of adverse events associated with significant morbidity . Monotherapy can be regarded, therefore, as the standard of care for febrile neutropaenic patients.

Clin Ther, 2002 May, 24(5), 719 - 35
Review of evidence for a connection between Chlamydia pneumoniae and atherosclerotic disease; Dugan JP et al.; BACKGROUND: Established risk factors account for no more than 50% of coronary artery disease cases; therefore, the search continues for other modifiable risk factors . In recent years, there has been renewed interest in the infectious theory of atherosclerosis . Chlamydia pneumoniae has been implicated as a potential cause of atherosclerotic disease . OBJECTIVE: This review discusses possible mechanisms of C pneumoniae involvement in atherosclerosis, summarizes the case-control studies and antibiotic trials completed, and identifies remaining questions about future therapy . METHODS: Published data were identified by a MEDLINE search of the English-language literature from 1966 through 2001 using the terms Chlamydia, atherosclerosis, and coronary artery disease . Relevant conference presentations and book chapters were also included . RESULTS: C pneumoniae antibodies are found in approximately 50% of middle-aged adults world-wide . These antibodies have been detected in atherosclerotic tissue by various methods, including microimmunofluorescence, and several studies have linked high antibody titers with increased risk of cardiovascular events . A few possible mechanisms for this perceived increase in risk have been proposed, such as induction of atheroma through damage to the endothelium, expression of procoagulant factor leading to thrombus formation, and production of cytokines resulting in increased inflammatory response . Results of animal studies suggest that early antibiotic treatment may reduce cardiovascular risk, but the first human studies have not produced conclusive results . CONCLUSIONS: Although a connection has been suggested, the precise mechanism by which C pneumoniae affects atherosclerosis has not yet been identified . Large-scale trials are needed to determine whether eradication of C pneumoniae reduces the incidence of cardiovascular events in humans.

Dtsch Med Wochenschr, 2002 Jun 21, 127(25-26), 1382 - 4
{Henoch-Schoenlein syndrome in an 80-year-old patient}; Rudiger JJ et al.; HISTORY AND CLINICAL FINDINGS: An 80-year old female patient, hospitalised with pneumonia and myocardial infarction, suddenly developed fever, dyspnoea, malaise, arthralgia and crampy abdominal pain . On the following day, she developed a petechial rash and on the 6 (th) day, macroscopic haematuria . On physical examination, the patient presented with a temperature of 40 degrees C, tachypnoea, tachycardia, and on auscultation coarse crepitations at the left lower base . The abdomen was tender upon deep palpation but bowel sounds were normal . Initially the petechial rash was located at the trunk, later progressing towards the extremities . INVESTIGATIONS: Chest X-ray and laboratory tests were consistent with left lower lobe pneumonia . The clinical picture was not consistent with any haematological causes, coagulopathy or any medication the patient was taking . Rheumatological blood tests (involving ANA, ANCA, rheumatoid factors) were basically negative . A skin biopsy revealed microvessel necrosis and IgA deposits, verifying Henoch-Schoenlein Purpura . An immune electrophoresis revealed a selective IgG-deficiency, which may explain the cause for the patient's recurrent pneumonias . COURSE: The patient recovered well under antibiotic treatment and skin lesions healed without sequelae . CONCLUSION: We present an unusual case of Henoch Schoenlein purpura associated with strictly petechial rash in an 80 year old female.

Clin Radiol, 2002 Jun, 57(6), 483 - 7
The sonographic appearance of acute focal pyelonephritis 8 years experience; Farmer KD et al.; AIM: Acute focal pyelonephritis (AFP) is a variant of pyelonephritis in which single or multiple discrete areas show changes of inflammation . The reported sonographic appearances of AFP are varied but are typically described as being echopoor . The purpose of this study was to review the sonographic appearances of AFP and attempt to explain the range of findings by correlation with clinical details . MATERIALS AND METHODS: We reviewed retrospectively the sonographic findings and medical records of 17 cases of AFP . The study group consisted of 13 women and four men (mean age 20 years) . Lesions were designated as echogenic, echopoor or of mixed echogenicity as compared to the adjacent renal cortex, and to the liver or spleen . RESULTS: The abnormal areas were echogenic in 12 patients, echopoor in three and of mixed echogenicity in two . An attempt was made to explain the variation in appearances by correlation with clinical details including the patient's age, the duration of symptoms, the length of antibiotic treatment and the presence of haematuria . CONCLUSION: Areas of acute focal pyelonephritis may be echogenic, echopoor or of mixed echogenicity . Our data would suggest that areas of increased echogenicity are more common . There is no discernible correlation with clinical findings .

Eur Rev Med Pharmacol Sci, 2001 Jul-Aug, 5(4), 127 - 9
Persistent eradication of Helicobacter pylori after systemic politherapy associated with periodontal pockets treatment with metronidazole and calcium sulphate; Tarullo A et al.; The sensitivity of H . Pylori to antibiotic treatment is well known . Politherapy (omeprazole or pantoprazole or ranitidine, amoxicillin and/or azithromycin and/or clarithromycin, metronidazole and bismuth citrate) notably changed the percentage of H . pylori eradication but rarely resolutive . Periodontal pockets treatment with topic metronidazole, calcium sulphate and potassium sulphate resulted active against bacteria included in periodontal pockets leading to a long-term H . pylori eradication (two years follow-up).

Fetal Diagn Ther, 2002 Jul-Aug, 17(4), 228 - 32
Effects of antibiotic treatment on the concentrations of interleukin-6 and interleukin-8 in cervicovaginal fluid; Matsuda Y et al.; OBJECTIVE: We investigated to see the effect of antibiotics on interleukin (IL)-6 and IL-8 in cervicovaginal fluid in patients with premature rupture of the membranes . STUDY DESIGN: Cervicovaginal fluid was sampled on admission and before delivery for measurement of IL-6 and IL-8 from 31 patients with less than 35 weeks of gestation . Concentrations of IL-6 and IL-8 were measured by ELISA . RESULTS: The concentrations of IL-6 in cervicovaginal fluid in patients who were delivered because of clinical chorioamnionitis with antibiotics (n = 6) were significantly higher than in patients who were delivered because of active labor with (n = 14, p = 0.0133) and without antibiotics (n = 11, p = 0.0067) . A significant change in the concentrations of IL-6 and IL-8 in cervicovaginal fluid was not observed in patients with and without antibiotics who were delivered because of active labor . CONCLUSIONS: The concentrations of IL-6 and IL-8 in cervicovaginal fluid might be influenced by the presence of clinical chorioamnionitis, but not by antibiotic administration .

Scand J Infect Dis, 2002, 34(4), 299 - 300
Septic arthritis caused by Chryseobacterium meningosepticum in an immunocompetent male; Gunnarsson G et al.; This is the first report of septic arthritis of the knee caused by Chryseobacterium meningosepticum . The infection was associated with a penetrating injury to the joint . The patient was cured by flushing of the joint and antibiotic treatment.

Scand J Infect Dis, 2002, 34(4), 243 - 7
No advantage of treating acute respiratory tract infections with azithromycin in a placebo-controlled study; Batieha A et al.; Acute respiratory tract infection (ARTI) is the commonest reason for which antibiotics are prescribed, despite the fact that ARTI is mostly of viral origin . The effectiveness of antibiotics in these illnesses is, at best, questionable . Jordan is a developing country where bacterial infections are thought to be more common than in developed countries and initially viral illnesses are frequently superimposed by bacterial infections . The present study represents an attempt to assess whether routine antibiotic treatment of ARTI has any beneficial effect on the course of the illness . The study was conducted in northern Jordan between 1 June and December 14, 2000 . Patients > or =8 y of age visiting either of 2 health centers and diagnosed by the physician with ARTI above the level of the bronchioles were assigned on an alternating basis to receive either azithromycin or placebo . Patients were assessed at their initial visit and were subsequently followed up after 3 d, 1 week and 2 weeks . A total of 185 patients were included in the study . Patients administered azithromycin or placebo did similarly in terms of the proportions improved or cured and the duration of illness . We conclude that routine use of antibiotics (azithromycin) in ARTI is unlikely to alter the course of the illness.

BMC Gastroenterol . 2002 Jun 03;2(1):14.
Bacterial cholangitis causing secondary sclerosing cholangitis: a case report; ter Borg PC et al.; BACKGROUND: Although bacterial cholangitis is frequently mentioned as a cause of secondary sclerosing cholangitis, it appears to be extremely rare, with only one documented case ever reported . CASE PRESENTATION: A 48-year-old woman presented with an episode of acute biliary pancreatitis that was complicated by pancreatic abcess formation . After 3 months she had an episode of severe pyogenic (E . Coli) cholangitis that recurred over the subsequent 7 months on a further two occasions . Initially, cholangiography suggested the presence of extra-biliary intrahepatic abcesses while repeated investigations demonstrated development of multiple segmental biliary duct strictures . After maintenance antibiotic treatment was started, no episodes of cholangitis occurred over a 14-month period . CONCLUSIONS: Sclerosing cholangitis can rapidly develop after an episode of bacterial cholangitis . Extra-biliary involvement of the hepatic parenchyma with abcess formation may be a risk factor for developing this rare but particularly severe complication.

Vet Rec, 2002 May 25, 150(21), 655 - 8
Evaluation of measurements of the conductivity of quarter milk samples for the early diagnosis of mastitis; Biggadike HJ et al.; Measurements of the conductivity of quarter milk samples were made in 31 cows in a 70-cow herd in southeast England, for a period of 15 weeks . Over this period, 42 per cent of cow-weeks and 20 per cent of quarter-weeks had an increase in quarter milk conductivity of 10 per cent of more compared with the mean conductivity of the previous 14 milkings . Fourteen per cent of quarter-weeks had an increase in conductivity of 15 per cent or more . The geometric mean somatic cell count (cell count) was higher in quarter-weeks with a 10 per cent or greater increase in conductivity than in quarter-weeks with a conductivity change of less than 10 per cent . At a conductivity threshold of 10 or 15 per cent and a cell count threshold of 200,000 or 400,000 cells/ml the specificity of this system was estimated to be 85 to 92 per cent, the sensitivity 40 to 54 per cent, the negative predictive value 87 to 93 per cent and the positive predictive value 33 to 55 per cent . The positive predictive value of the individual quarter milk conductivity was insufficiently accurate to be used as the sole criterion for the selection of quarters for early antibiotic treatment.

Pediatr Neurosurg, 2002 May, 36(5), 256 - 9
Duration of antibiotic therapy for the treatment of shunt infection: a surgeon and patient survey; Arthur AS et al.; The ideal duration of antibiotic treatment for shunt infection remains a major unanswered question in pediatric neurosurgery . To date, no study has objectively determined the best length of treatment, i.e . that which minimizes both the length of hospital stay and the chance of reinfection . This study was undertaken to determine whether an increase in reinfection risk would be tolerated if the duration of therapy were shortened . Sixty-one members of the American Society of Pediatric Neurosurgeons (44 responding) and 831 patients or parents of patients with shunts (385 responding) were surveyed using similar questionnaires . Sixty-four percent of neurosurgeons (28/44) and 54% of patients (178/325) responding to the survey would tolerate an increased reinfection risk in order to gain a shorter duration of treatment . These data support the feasibility of a planned randomized study to determine the ideal length of antibiotic treatment for shunt infection .

Plast Reconstr Surg, 2002 Jun, 109(7), 2265 - 74
Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study; Alderman AK et al.; In this study, the effects of procedure type, timing, and other clinical variables on complication rates in mastectomy reconstruction were prospectively evaluated . Using a prospective cohort design, women undergoing first-time, immediate or delayed breast reconstruction were recruited from 12 centers and 23 plastic surgeons . Complication data for expander/implant, pedicle transverse rectus abdominis musculocutaneous (TRAM) flap, and free TRAM flap procedures were evaluated 2 years after surgery in 326 patients . For each patient, the total number of complications was recorded and the complication data were dichotomized in two ways: (1) total complications and (2) major complications (those requiring reoperation, rehospitalization, or nonperioperative intravenous antibiotic treatment) . The effects of procedure type, timing, radiotherapy, chemotherapy, age, smoking, and body mass index on complication rates were analyzed using logistic regression . Immediate reconstructions had significantly higher total as well as major complication rates, compared with delayed procedures (p = 0.011 and 0.005, respectively) . Furthermore, higher body mass indexes were associated with significantly higher total and major complication rates (p = 0.005 and p < 0.001, respectively) . No significant effects on complication rates were noted for procedure type or for the other independent variables, although there was evidence of trends for higher total and major complication rates in implant patients who received radiotherapy and a trend for higher major complication rates in TRAM flap patients who received chemotherapy . It was concluded that (1) immediate reconstructions were associated with significantly higher complication rates than delayed procedures, and (2) procedure type had no significant effect on complication rates.

Circulation, 2002 Jun 4, 105(22), 2646 - 52
Roxithromycin treatment prevents progression of peripheral arterial occlusive disease in Chlamydia pneumoniae seropositive men: a randomized, double-blind, placebo-controlled trial; Wiesli P et al.; BACKGROUND: Evidence has been provided that the atherosclerotic process may be associated with chronic infection with Chlamydia pneumoniae . The effect of antibiotic treatment on peripheral arterial occlusive disease has not been investigated yet . METHODS AND RESULTS: Forty C pneumoniae seropositive men suffering from peripheral arterial occlusive disease were randomly assigned to receive either roxithromycin (300 mg daily) or placebo for 28 days . During the 2.7-year follow-up, the number of invasive revascularizations per patient, the walking distance before intervention (in patients without intervention at study end), and the change of carotid plaque size were assessed . Five interventions were performed on 4 patients (20%) in the roxithromycin group, and 29 interventions were performed on 9 patients (45%) in the placebo group . Limitation of walking distance to 200 m or less was observed in 4 patients (20%) in the roxithromycin group and in 13 patients (65%) in the placebo group . The effect of macrolide treatment on the number of interventions per patient and on preinterventional walking distance was significant . Possible confounding variables such as classical vascular risk factors were excluded by multiple regression analyses . Carotid plaque areas monitored over 6 months decreased in the roxithromycin group (mean relative value, 94.4%) but remained constant in the placebo group (100.2%) . Regression of carotid plaque size observed in roxithromycin-treated patients was significant for soft plaques . CONCLUSIONS: This study indicates that macrolide treatment for 1 month is effective in preventing C pneumoniae seropositive men from progression of lower limb atherosclerosis for several years.

J Chemother, 1991 Jan, 3 Suppl 1, 131 - 5
Cefixime does not affect polymorphonuclear cell and monocyte functions from chronic lymphoid leukemia patients and from healthy donors; Liberto MC et al.; It is well documented that to evaluate the efficacy of an antibiotic treatment it is important to know the relationships between the drug and the cells belonging to the immune system, by studying the possible effects on some cellular functions, particularly in immunosuppressed and immunodeficient patients . We describe the influence of cefixime, a new orally administered cephalosporin, on some polymorphonuclear cell (PMN) and monocyte functions from healthy donors and from patients affected by chronic lymphoid leukemia (CLL).

Br J Gen Pract, 2002 Mar, 52(476), 187 - 90, 193
Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study; Little P et al.; BACKGROUND: Systematic reviews of antibiotic treatment of common acute respiratory tract infections (RTIs) suggest modest symptomatic benefit, but provide limited evidence that prescribing prevents complications . AIM: To assess the relationship between penicillin prescribing (the most commonly used group of antibiotics for RTIs) and hospital admission with complications . DESIGN OF STUDY: Data linkage study . SETTING: Ninety-six health authorities of England for the year 1997-1998 . METHOD: Hospital admissions related to RTIs were linked with prescribing analysis and cost (PACT) data . RESULTS: There was close correlation between items of penicillin use and total antibiotic use (r = 0.96) . After controlling for SMR, age, sex, and Townsend score, a one-unit increase in penicillin use (items dispensed per capita) was associated with a reduction in annual incidence per 10,000 of admissions for quinsy (-3.55 admissions, 95% confidence interval {CI} = -6.85 to -0.26), and mastoiditis (square root of incidence of admissions = -1.05, 95% CI = -1.82 to -0.27) . This does not represent lower referral thresholds among higher prescribers as higher prescribing was associated with more admissions for tonsillectomy and overall admissions . Increasing prescribing by 2000 items of penicillin for a practice of 10,000 patients could possibly prevent one admission for either mastoiditis or quinsy . CONCLUSION: Higher antibiotic prescribing is associated with significantly fewer admissions with major complications . However, the overall size of the effect is modest and it is difficult to advocate an overall increase in prescribing to prevent complications . Future research should concentrate on finding better methods of targeting antibiotics to individuals at risk of poor outcome.

Scand J Infect Dis, 2002, 34(3), 163 - 6
Use of PCR and culture for detection of Mycobacterium tuberculosis in specimens from patients with normal and slow responses to chemotherapy; Velayati AA et al.; In order to examine the utility of PCR as a tool for monitoring the response to short-course chemotherapy, clinical data from 162 tuberculosis patients with drug-susceptible cultures and variables associated with a slow response to antibiotic treatment were retrospectively evaluated . Initial samples were positive by smear in 106 patients and by PCR in 156 patients . A rapid response to therapy was found in 132 patients who had both smear and culture-negative results after 2 months of treatment . After 6 months of therapy, 5 other patients in this group were considered clinically cured but 20 patients had positive cultures . For these 20 patients with a slow response to therapy, treatment was continued for an additional 2-4 months and 15 patients were subsequently cured . However, of all the cured patients 7 had PCR-positive samples at the end of treatment . When these cases were correlated with therapeutic outcome, it was found that 3 of the PCR-positive but none of the PCR-negative patients had a clinical relapse during subsequent follow-up . We conclude that culture and PCR tests are highly informative when used to control the rate of response to therapy . A post-treatment positive result on PCR may be associated with a poor clinical outcome or may predict the likelihood of clinical relapse . Culture and PCR tests, as opposed to smear results, may be the key parameters for individually guiding the duration of treatment in TB patients with a poor response to standard therapy.

J Hosp Infect, 2002 Apr, 50(4), 298 - 303
Changes in the appearance and treatment of deep sternal infections; Tegnell A et al.; The Department of Thoracic Surgery at the University Hospital, Linkoping, Sweden, has actively followed up infectious complications of cardiac surgery since 1989 . The aim of this study was to investigate whether changes occurred during the 1990s in the appearance and the management of deep infections . This was done by studying patients undergoing surgical revision of infected wounds . We studied 42 patients during 1990-94 and 49 during 1997-98 (total number of operations in these periods, 3075 and 1646, respectively) . Pre-operative and intra-operative variables were recorded for the two patient populations . The proportion of cardiac surgery procedures followed by a surgical revision for an infection in the sternal wound increased between the two periods (1.4% vs . 3.0%) . Variables associated with the surgical procedures preceding the infection remained unchanged . In the later period, treatment was started earlier (64 vs . 24 days), and the length of antibiotic treatment was decreased (115 vs . 72 days) . The incidence of osteomyelitis of the sternal bone was lower (61% vs . 27%) . It appears that as the proportion of patients undergoing surgical revision increased, management of the infections became more effective, with aggressive surgical and antibiotic treatment policies and shorter treatment periods . This indicates that in order to evaluate the overall impact of measures designed to reduce infections after cardiac surgery, not only the incidence of infection needs to be followed up but other factors also need to be taken into account .

J Hosp Infect, 2002 May, 51(1), 59 - 64
Coronavirus-related nosocomial viral respiratory infections in a neonatal and paediatric intensive care unit: a prospective study; Gagneur A et al.; The incidence of nosocomial viral respiratory infections (NVRI) in neonates and children hospitalized in paediatric and neonatal intensive care units (PNICU) is unknown . Human coronaviruses (HCoV) have been implicated in NVRI in hospitalized preterm neonates . The objectives of this study were to determine the incidence of HCoV-related NVRI in neonates and children hospitalized in a PNICU and the prevalence of viral respiratory tract infections in staff . All neonates (age< or =28 days) and children (age>28 days) hospitalized between November 1997 and April 1998 were included . Nasal samples were obtained by cytological brush at admission and weekly thereafter . Nasal samples were taken monthly from staff . Virological studies were performed, using indirect immunofluorescence, for HCoV strains 229E and OC43, respiratory syncytial virus (RSV), influenza virus types A and B, paramyxoviruses types 1, 2 and 3 and adenovirus . A total of 120 patients were enrolled (64 neonates and 56 children) . Twenty-two samples from 20 patients were positive (incidence 16.7%) . In neonates, seven positive samples, all for HCoV, were detected (incidence 11%) . Risk factors for NVRI in neonates were: duration of hospitalization, antibiotic treatment and duration of parenteral nutrition (P<0.01) . Monthly prevalence of viral infections in staff was between 0% and 10.5%, mainly with HCoV . In children, 15 samples were positive in 13 children at admission (seven RSV, five influenza and three adenovirus) but no NVRI were observed . In spite of a high rate of community-acquired infection in hospitalized children, the incidence of NVRI with common respiratory viruses appears low in neonates, HCoV being the most important pathogen of NRVI in neonates during this study period . Further research is needed to evaluate the long-term impact on pulmonary function .

Enferm Infecc Microbiol Clin, 2002 May, 20(5), 212 - 8
{Laboratory diagnosis of pertussis . Role of serology}; Sanz Moreno JC et al.; Culture is the reference method for the diagnosis of infection by Bordetella pertussis . Nevertheless, delayed sample collection and previous antibiotic treatment can limit culture sensitivity . In principle, direct immunofluorescence provides immediate diagnosis . It is, however, a subjective procedure that shows low sensitivity and specificity . PCR techniques increase culture sensitivity while maintaining high specificity, but their performance decreases along the evolution of the disease . Serologic methods are the main alternative for cases in which diagnosis is delayed . Current recommendations center on ELISA techniques that include purified antigens, such as filamentous hemaglutinin, and particularly, pertussis toxin . Traditionally, serological diagnosis requires confirmation by demonstrated seroconversion, but now the possibility of diagnosis based on titration of a single serum sample is being evaluated.

Radiat Res, 2002 Jun, 157(6), 642 - 9
Administration of recombinant human IL11 after supralethal radiation exposure promotes survival in mice: interactive effect with thrombopoietin; Van der Meeren A et al.; In the present study, we evaluated the therapeutic potential of recombinant human IL11 in lethally irradiated C57BL6/J mice exposed to gamma rays . IL11 administered for 5 consecutive days beginning 2 h after total-body irradiation with 8 or 9 Gy 60Co gamma rays resulted in a significant increase in 30-day survival . When IL11 was administered, only a slight improvement in the hematopoietic status (both blood cell counts and progenitor cells) was observed after an 8-Gy exposure, and no improvement in hematopoietic reconstitution was observed after 9 Gy total-body irradiation . The enhancement of fibrinogen in the plasma of irradiated animals suggested the importance of infections in the death of animals . IL11 was able to limit the increase in fibrinogen levels . However, prevention of bacterial infections by antibiotic treatment, although it delayed death, was ineffective in promoting survival either in placebo-treated and IL11-treated mice . IL11 was administered along with thrombopoietin (TPO) or bone marrow transplantation to limit the hematopoietic syndrome, in addition to antibiotic treatment . When IL11 was combined with TPO, a potent stimulator of hematopoiesis, the survival of animals which had been irradiated with 10 Gy 137Cs gamma rays was increased significantly compared to those treated with IL11 or TPO alone . Furthermore, an interactive effect of TPO and IL11 on hematopoietic reconstitution was observed . Similarly, IL11 in combination with bone marrow transplantation enhanced survival after 15 Gy 137Cs gamma rays . These data suggest that the effect of IL11 on the hematopoietic system is only moderate when it is used alone in supralethally irradiated mice but that the effect is improved in the presence of a hematopoietic growth factor or bone marrow transplantation.

J Cancer Educ, 2002 Spring, 17(1), 12 - 8
General practitioners' attitudes and ethical decisions in end-of-life care after a year of interactive Internet-based training; Hinkka H et al.; BACKGROUND: Personal characteristics affect physicians' end-of-life decisions . Education in palliative care (PC) faces a challenge in influencing doctors' attitudes and decision making in PC . A one-year Internet-mediated education project was arranged for general practitioners in Finland to provide postgraduate education in PC . METHODS: A questionnaire was sent before and after the project to the education group (EG, n = 79) and a control group (CG, n = 100) . Treatment decisions for presented scenarios and attitudes toward PC were elicited . RESULTS: EG doctors had previously participated in postgraduate training in PC more often than had CG doctors (93% vs 29%) . For a young terminal cancer patient, EG doctors chose CPR less often than did CG doctors (7% vs 33%, p = 0.004); 30% of EG doctors would have continued antibiotic treatment in the case of a terminal cancer patient, vs 55% of CG doctors (p = 0.023) . EG doctors more often agreed with the statement "Terminal care is satisfying" (p < 0.001) . Treatment decisions or attitudes did not change significantly in either group during the year, the EG doctors were more satisfied with their work after the project . CONCLUSION: There are substantial differences in decision making between those who have experience and special interest in the subject and those who do not . To achieve the goals of education in PC, the most difficult target group, the "silent majority" of doctors, should be reached.

Soc Sci Med, 2002 Apr, 54(7), 1111 - 30
Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters; Stivers T; This article examines how parents and pediatricians negotiate antibiotic prescribing decisions in cases where parents overtly advocate this medication . Using the methodology of conversation analysis, this paper examines audio and videotaped acute care pediatric encounters and discusses four primary ways in which parents raise antibiotics in pediatric encounters . These formulations vary in their directness with indirect formulations being more common . The article argues that both parents and physicians are oriented to antibiotics as negotiable in and through their interaction . Finally, in contrast with existing research, this study suggests that overtly advocating for antibiotic treatment is relatively unusual; future research will need to incorporate an understanding of the effect of both explicit and implicit ways parents communicate pressure for prescription treatment.

Vet Parasitol, 2002 May 30, 106(1), 75 - 82
Electron microscopic and molecular identification of Wolbachia endosymbionts from Onchocerca lupi: implications for therapy; Egyed Z et al.; It was recently demonstrated that Wolbachia intracellular bacteria (alpha 2 proteobacteria, Rickettsiales) living in filarial nematodes are obligatory symbionts of their hosts . Herein, we report the electron microscopic and 16S ribosomal DNA-based (16S rDNA) identification of the endobacteria harboring in Onchocerca lupi . The worm nodules containing the nematodes were removed from three Hungarian dogs naturally infected with O . lupi . Wolbachia-like endobacteria were detected by electron microscopy in the lateral chords of both adult worms and microfilariae . The endosymbionts in O . lupi resemble in location, size, and morphology the wolbachiae found in other filariae . The presence of wolbachiae in O . lupi was also confirmed by PCR amplification of the 16S rDNA of the bacteria . The 16S rDNA-based phylogenetic analysis revealed that the endosymbionts of O . lupi infecting dogs belong to the supergroup C of Wolbachia pipientis and are not identical with those of other Onchocerca spp . sequenced so far . Since intermittent treatment with oxytetracycline has adulticid and microfilaricid activity by depletion of Wolbachia endobacteria, this antibiotic treatment regimen may offer an alternative of ivermectin or diethylcarbamazine in the suppression of postoperative microfilaridermia in Onchocerca-infected dogs and may prevent relapse.

Med Clin North Am, 2002 Mar, 86(2), 261 - 84
Neurologic aspects of Lyme disease; Coyle PK et al.; Lyme disease has emerged as a major infection with frequent neurologic manifestations . These manifestations probably reflect several predominantly indirect pathogenetic mechanisms and involve host, vector, and organism factors . With early diagnosis and appropriate antibiotic treatment, patients do well . Because culture is not reliable, diagnosis has relied on positive serology to document exposure . Serology should improve as second-generation assays become available . Although there is a preventive vaccine based on the lipoprotein OspA, newer vaccines in development may prove more desirable . Lyme disease provides a valuable model to study how infectious pathogens cause neurologic disease.

Thorax, 2002 May, 57(5), 465 - 7
Migratory pulmonary infiltrates in a patient with rheumatoid arthritis; Mehandru S et al.; The case history is described of an elderly man with rheumatoid arthritis receiving treatment with sulfasalazine and the cyclooxygenase-2 inhibitor celecoxib who presented with severe shortness of breath, cough, and decreased exercise tolerance . The chest radiograph showed unilateral alveolo-interstitial infiltrates and a biopsy specimen of the lung parenchyma showed changes consistent with acute eosinophilic pneumonia . Antibiotic treatment was unsuccessful, but treatment with steroids and discontinuation of sulfasalazine and celecoxib resulted in a marked clinical improvement confirmed by arterial blood gas analysis . The condition may have developed as an adverse reaction either to sulfasalazine or to celecoxib, although hypersensitivity to the latter has not previously been reported.

J Fam Pract, 2002 Apr, 51(4), 329 - 36
Is roxithromycin better than amoxicillin in the treatment of acute lower respiratory tract infections in primary care? A double-blind randomized controlled trial; Hopstaken RM et al.; OBJECTIVE: To assess the efficacy of roxithromycin relative to amoxicillin . STUDY DESIGN: We conducted a double-blind randomized controlled trial of oral 500 mg amoxicillin 3 times per day vs oral 300 mg roxithromycin once a day for 10 days . POPULATION: We included 196 adults who had presented to a general practitioner with lower respiratory tract infection (LRTI) and, in the physician's opinion, needed antibiotic treatment . OUTCOMES MEASURED: We measured clinical response after 10 and 28 days, defined in 4 ways: (1) decrease in LRTI symptoms; (2) complete absence of symptoms; (3) decrease in signs; and (4) complete absence of signs . Self-reported response included the decrease in symptoms and the time until resumption of impaired or abandoned daily activities on days 1 through 10, 21, and 27 . RESULTS: Clinical cure rates after the completion of antibiotic treatment (10 days) were not significantly different for the 2 groups . After 28 days, the roxithromycin group showed no increase in cure rate as evidenced by the decrease in symptoms, indicating a significantly lower cure rate . However, this difference did not alter physicians' overall conclusion after complete follow-up that 90% of patients, regardless of age, had been effectively treated with either amoxicillin or roxithromycin . CONCLUSIONS: The surplus value of roxithromycin was not confirmed . Amoxicillin remains a reliable first-choice antibiotic in the treatment of LRTI in general practice.

Emerg Infect Dis, 2002 Apr, 8(4), 398 - 401
Outcomes of treated human granulocytic ehrlichiosis cases; Ramsey AH et al.; We conducted a case-control study in Wisconsin to determine whether some patients have long-term adverse health outcomes after antibiotic treatment for human granulocytic ehrlichiosis (HGE) . A standardized health status questionnaire was administered to patients and controls matched by age group and sex . Consenting patients provided blood samples for serologic testing . Among the 85 previously treated patients, the median interval since onset of illness was 24 months . Compared with 102 controls, patients were more likely to report recurrent or continuous fevers, chills, fatigue, and sweats . Patients had lower health status scores than controls for bodily pain and health relative to 1 year earlier, but there was no significant difference in physical functioning, role limitations, general health, or vitality measures . The HGE antibody titer remained elevated in one patient; two had elevated aspartate aminotransferase levels . HGE may cause a postinfectious syndrome characterized by constitutional symptoms without functional disability or serologic evidence of persistent infection.

Curr Opin Infect Dis, 2001 Dec, 14(6), 727 - 31
A new approach to the treatment of filariasis; Taylor MJ et al.; The symbiosis of filarial nematodes and intracellular Wolbachia bacteria has recently been exploited as a target for antibiotic therapy of filariasis . Antibiotic treatment of filarial nematodes results in sterility and inhibits larval development and adult worm viability . In the first trial on human onchocerciasis depletion of bacteria following treatment with doxycycline resulted in a complete and long-term block of embryogenesis . Bacteria are unable to repopulate nematode tissues up to 18 months after depletion, suggesting these effects may be permanent . Following ivermectin treatment, individuals given antibiotic therapy showed sustained reductions in skin microfilariae, with the majority of people remaining microfilarial negative 12-18 months after treatment . Since Wolbachia also contribute to the inflammatory pathogenesis of filarial disease, antibiotic therapy could, in addition to effects on worm fertility or viability, prevent the onset or development of filarial pathology.

J Pediatr Orthop, 2002 May-Jun, 22(3), 317 - 20
Short-term intravenous antibiotic treatment of acute hematogenous bone and joint infection in children: a prospective randomized trial; Jaberi FM et al.; Thirty-three cases of acute hematogenous bone or joint infection in children were randomly treated with short-term (7 days for joint infection, 10 days for bone infection) or long-term (14 days and 21 days, respectively) intravenous antibiotics after surgical drainage . The treatment outcome was measured through a detailed scoring system that included the ability to eradicate infection, the functional status of the limb, and the radiographic appearance of the bone and joint . The results were similar in both groups, showing the added benefit of a shorter hospital stay for children with blood-borne musculoskeletal infection . The use of this scoring system in choosing the route of antibiotic administration is recommended.

Clin Microbiol Infect, 2002 Feb, 8(2), 70 - 3
Procalcitonin and other markers of infection . What should be their role in clinical practice?
van Dissel JT.
Clinicians are always faced with a decision when confronted with a febrile patient; they must decide between what is an infectious condition and what is not, and between what merits hospital observation, what requires empirical antibiotic treatment and what needs outpatient follow-up . In this respect, judgement based on medical history and physical examination outweigh the predictive value of various laboratory markers of infection, as the latter generally reflect a nonspecific reaction of the host to widely different infectious and inflammatory stimuli . In the evaluation of specific subgroups of patients, e.g . those in the intensive care unit, laboratory tests should also preferably form a continuum with medical history and physical examination, aimed at clarifying host condition, the setting and the source of a possible infection.

Southeast Asian J Trop Med Public Health, 2001 Sep, 32(3), 488 - 93
Perinatal dengue infection; Kerdpanich A et al.; We report a case of vertical transmission of dengue infection in an infant . The mother's was a term pregnancy with a history of chronic hypertension . She presented with high fever of 3 days duration 5 days prior to delivery . Her initial complete blood count showed platelet count of 64,000/mm3 . Dengue hemorrhagic fever was diagnosed 2 days later and symptomatic treatment was given . During labor her platelets dropped to 11,000/mm3 and platelet concentrate was given . Cesarean section was performed due to prolonged second stage of labor . Her infant was normal at birth except for petechiae on the left thigh . The child's platelet count was 34,000/mm3 and low grade fever was detected on the first day . Clinical sepsis was suspected and antibiotic treatment was started and continued for 4 days until all the cultures came back as negative . Both mother and her baby made an uneventful recovery and were discharged 6 days after delivery with normal platelet counts . Maternal blood was positive for IgM antibody to dengue virus . Both cord blood and the baby's blood were positive for dengue virus serotype 2 by PCR.

Harefuah, 2002 Mar, 141(3), 237 - 8, 316, 315
{Splenic abscess as an unusual manifestation of colonic carcinoma}; Leibovitz I et al.; A patient was admitted to the Internal Medicine Department after suffering from fever for 4 days . A splenic abscess was found in an ultrasound examination and was confirmed by an abdominal computerized tomography and galium scan . Antibiotic treatment was successful, however barium enema was performed due to the lack of a predisposing factor for this unusual abscess . A polypoid mass was found in the splenic flexure of the colon . Colonoscopy and histologic examination confirmed the mass to be colonic adenocarcinoma . Either an endoscopic examination or barium enema are recommended to exclude colonic lesions in cases of splenic abscess without an obvious cause.

Eur J Clin Microbiol Infect Dis, 2002 Feb, 21(2), 133 - 6
Outbreak of African tick-bite fever in six Italian tourists returning from South Africa; Caruso G et al.; In May 1999, a cluster of cases of African tick-bite fever was detected in six Italian tourists who had returned from South Africa . All of the patients had moderate fever and cutaneous eschars . Regional lymphangitis was observed in three of the patients and skin rash in two . By comparing the number of eschars with the number of detectable bite sites it was suggested that at least two-thirds of the biting vectors were capable of transmitting Rickettsia africae . The clinical course of disease was mild in all cases, and all but one of the patients recovered spontaneously before antibiotic treatment was initiated . The diagnosis of African tick-bite fever was confirmed serologically using both microimmunofluorescence and Western blot tests.

Lancet Infect Dis, 2002 Apr, 2(4), 231 - 42
Monotherapy or aminoglycoside-containing combinations for empirical antibiotic treatment of febrile neutropenic patients: a meta-analysis; Furno P et al.; We set out to compare the efficacy of antibiotic monotherapy with that of combination therapy including an aminoglycoside for empirical treatment of febrile neutropenic cancer patients . We did a meta-analysis of 29 randomised clinical trials pooling data from 4795 febrile episodes and a subset of 1029 bacteraemic episodes by both fixed and random effects models . Outcome measure was clinical failure of antibiotic treatment, defined as modification of the initially allocated regimen or death during treatment . In febrile episodes, the pooled odds ratio (OR) of clinical failure with monotherapy versus combination therapy was 0.88, with 95% CI from 0.78 to 0.99 by the fixed effects model, and 0.87 with 95% CI from 0.75 to 1.01 by the more conservative random effects model . For bacteraemic episodes, the pooled OR of failure with monotherapy was 0.70 (0.54 to 0.92) by the fixed effects model, and 0.72 (0.54 to 0.95) by the random effects model . We conclude that monotherapy has been as effective as aminoglycoside-containing combinations for empirical treatment of febrile neutropenia.

Endoscopy, 2002 Apr, 34(4), 343 - 6
The possible involvement of micro-organisms other than Helicobacter pylori in the development of rectal MALT lymphoma in H . pylori-negative patients; Nakase H et al.; It remains unclear whether lymphoma of the mucosa-associated lymphoid tissue (MALT) in the extragastric organs is related to Helicobacter pylori infection or not . This report describes three patients with rectal MALT lymphoma negative for H . pylori infection, all of whom showed disease regression after being treated with antibiotics . One patient had MALT lymphoma in both the descending colon and the rectum; the other two patients had rectal disease only . None of the patients had chronic gastritis which was detectable either endoscopically or histologically and H . pylori infection was completely ruled out by various methods, including a urease breath test . These patients received antibiotic therapy . In all the patients, regression of MALT lymphoma was observed endoscopically and histologically, and polymerase chain reaction revealed that a previously observed rearranged band of immunoglobulin heavy chain had also disappeared after antibiotic treatment . These cases therefore suggest involvement of micro-organisms other than H . pylori in the development of rectal MALT lymphoma.

Ned Tijdschr Tandheelkd, 1999 Sep, 106(9), 340 - 1
{Syndromes 14 . Rendu-Osler-Weber disease}; Baart JA et al.; The Rendu-Osler-Weber disease is due to an autosomal dominant disease with multiple telangiectasia in skin and mucosa . Recurrent bleeding of the nose is due to telangiectasia of the nasal mucosa . Haemorrhage of the oral mucosa also occurs . Extensive arteriovenous malformations can be present in lungs, liver and brain . Treatment of bleedings in the oral mucosa is easily possible by means of coagulation . Patients with pulmonary arteriovenous malformations should receive prophylactic antibiotic treatment before extractions, removal of third molars and subgingival curettage.

J Gen Intern Med, 2002 Mar, 17(3), 230 - 4
Antibiotic treatment of acute bronchitis in smokers: a systematic review; Linder JA et al.; OBJECTIVE: Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis . We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis . DESIGN: A medline search was done using the keywords bronchitis, cough, and antibiotics to identify English language articles published from January 1966 to September 2001 . Randomized, placebo-controlled trials of antibiotics in previously healthy smokers and nonsmokers with acute bronchitis were included . MEASUREMENTS AND MAIN RESULTS: For each study, we abstracted information on design, size, inclusion criteria, patient characteristics, and outcomes . Of 2,029 articles in the original search, 109 relevant articles were retrieved and reviewed . There have been no studies specifically addressing antibiotic use in smokers with acute bronchitis . Nine randomized, placebo-controlled trials of antibiotics have included 774 patients and over 276 smokers . Lack of subgroup reporting for smokers precluded meta-analysis . In 7 trials, smoking status did not predict or alter patients' response to antibiotics . In one trial, trimethoprim/sulfamethoxazole resulted in less-frequent cough overall, but not among smokers . In another trial, erythromycin reduced symptom scores only among nonsmokers while antibiotic-treated smokers had a trend toward higher symptom scores . CONCLUSION: Although no trials have specifically addressed antibiotic use in smokers with acute bronchitis, existing data suggest that any benefit of antibiotics is the same or less for smokers than for nonsmokers.

In Vitro Cell Dev Biol Anim, 2002 Feb, 38(2), 86 - 9
Comparative antibiotic eradication of mycoplasma infections from continuous cell lines; Uphoff CC et al.; Accumulating data implicate mycoplasma contamination as the single biggest problem in the culture of continuous cell lines . Mycoplasma infection can affect virtually every parameter and functional activity of the eukaryotic cells . A successful alternative to discarding infected cultures is to attempt to eliminate the contaminants by treatment with specific and efficient antimycoplasma antibiotics . The addition of antibiotics to the culture medium during a limited period of time (1-3 wk) is a simple, inexpensive, and very practical approach for decontaminating continuous cell lines . Here, we examined the effectiveness of several antibiotic treatment protocols that we have employed routinely in our cell lines bank . On an aggregate, 673 cultures from 236 chronically mycoplasma-positive cell lines were exposed to one of the following five antibiotic regimens: mycoplasma removal agent (quinolone; a 1-wk treatment), enrofloxacin (quinolone; 1 wk), sparfloxacin (quinolone; 1 wk), ciprofloxacin (quinolone; 2 wk), and BM-Cyclin (alternating tiamulin and minocycline; 3 wk) . The mycoplasma infection was permanently (as determined by three solid mycoplasma detection assays) eliminated by the various antibiotics in 66-85% of the cultures treated . Mycoplasma resistance was seen in 7-21%, and loss of the culture as a result of cytotoxically caused cell death occurred in 3-11% of the cultures treated . Overall, 223 of the 236 mycoplasma-positive cell lines could be cured in a first round of antibiotic treatment with at least one regimen . Taken together, 95% of the mycoplasma-infected cell lines were permanently cleansed of the contaminants by antibiotic treatment, which validates this approach as an efficient and technically simple mycoplasma eradication method.

Wiad Lek, 2001, 54(11-12), 668 - 73
{Estimation of platelet counts and their morphological parameters in patients infected by borrelia burgdorferi}; Zajkowska JM et al.; Platelet counts and their morphologic parameters in patients with Lyme borreliosis before and after antibiotic therapy (4 weeks of treatment) were estimated . 30 patients aged 17-60, x = 41 were evaluated: 7 with Erythema migrans, 3 patients with neuroborreliosis in the from Lymphocytic meningitis and 20 ones with Lyme arthritis . Control group consisted of 19 healthy persons aged 34-52, x = 43 . Hematologic analyser Coulter MAXM was used for testing PLT, MPV, PCT and PDW . The results indicated that patients with Lyme boreliosis have decreasing platelet count with simultaneously increasing their volume in comparison with healthy control . It may result from the involement of platelets in defense mechanisms of infected host . The decrease of platelet count after the antibiotic treatment in comparison with the control group may be the reflection of influence of antibiotic treatment on thrombopoesis.

J Spinal Disord Tech, 2002 Apr, 15(2), 110 - 7
Osteomyelitis of the cervical spine: a potentially dramatic disease; Schimmer RC et al.; Osteomyelitis of the cervical spine is a rare disease, representing only 3% to 6% of all cases of vertebral osteomyelitis . In contrast with other locations of spinal infections, osteomyelitis of the cervical spine can be a much more dramatic and rapidly deteriorating process, leading to early neurologic deficit . Thus, the disease must be diagnosed quickly and appropriate therapy initiated as soon as possible . The clinical course, therapy, and outcome of 15 patients treated for osteomyelitis of the cervical spine are presented . Nine of 15 patients presented with a neurologic deficit at the time of diagnosis . Surgical treatment consisted of radical debridement of the infected bone and either immediate bone grafting and stabilization as a one-step procedure or interval antibiotic treatment before bone grafting and surgical stabilization as a second procedure . A favorable outcome was achieved by early and aggressive surgical intervention, including complete resolution of neurologic deficits in more than 50% of the patients and complete bony fusion in all but one patient . The authors prefer additional posterior rather than anterior stabilization alone to perform fusion over a shorter distance involving only the infected segments.

Dig Liver Dis, 2002 Jan, 34(1), 70 - 83
Treatment of Helicobacter pylori infection . Indications and regimens: an update; Bazzoli F et al.; The management of Helicobacter pylori infection is still surrounded by controversy and uncertainties . Indications and correct application of current regimens for Helicobacter pylori infection are still considered a matter of debate . Regarding indications, only peptic ulcer and mucosa associated lymphoid tissue lymphoma are considered clear indications for treatment . In other conditions, such as atrophic gastritis, post gastric cancer resection, first-degree relatives of gastric cancer patients, dyspeptic patients, patients with gastro-oesophageal reflux disease and non-steroidal anti-inflammatory drug users, the value of Helicobacter pylori eradication is still controversial . The regimens for first-line and second-line treatment of Helicobacter pylori infection have been recommended by the Maastricht 2 Consensus Report . Although all the treatments are considered to be effective, physicians still do not agree on what first-line regimen should be used . Furthermore, a consensus on the duration of the antibiotic treatment is still lacking, although Maastricht guidelines for treatment of Helicobacter pylori infection recommend a one-week therapy . Also regimens, as a third-line treatment, and methods to improve compliance and clinical outcome are still a matter of debate . All these points will be considered in the present review

Aust Fam Physician, 2002 Mar, 31(3), 225 - 31
Sticky eye, tricky diagnosis; Coote MA; BACKGROUND: Infective conjunctivitis is common and mostly responds well to supportive management and/or empiric antibiotic treatment . At times the differential diagnosis includes more serious conditions that potentially threaten vision . Recurrence and treatment failures are relatively common . OBJECTIVE: To outline the usual clinical appearance of conjunctivitis and its management . To explore the clinical appearance (with the help of case studies) of conditions that have been mistaken for conjunctivitis, and to consider some of the conditions that may coexist that contribute to recurrence and nonresponsiveness . DISCUSSION: Empiric treatment for presumed bacterial conjunctivitis remains an appropriate course of action . Care must be taken in certain groups who are at high risk of complications . Careful review of the clinical appearance and consideration of other possible diagnoses is mandatory in nonresponding patients.

Am J Clin Nutr, 2002 Apr, 75(4), 668 - 75
Increased plasma fatty acid concentrations after respiratory exacerbations are associated with elevated oxidative stress in cystic fibrosis patients; Wood LG et al.; BACKGROUND: Oxidative stress and depleted antioxidant defenses occur in stable cystic fibrosis patients . During acute infection, the balance between oxidants and antioxidants may be further disturbed . OBJECTIVE: We examined the oxidative stress during acute infection in cystic fibrosis patients by measuring 8-iso-prostaglandin F(2 alpha) (8-iso-PGF(2 alpha)) and antioxidant defenses in relation to dietary intake, fatty acid status, immune function, and clinical status . DESIGN: Plasma concentrations of total 8-iso-PGF(2 alpha), vitamins E and C, beta-carotene, zinc, selenium, and copper; plasma fatty acid compositions; erythrocyte glutathione concentrations; glutathione peroxidase and superoxide dismutase activity; sputum glutathione and 8-iso-PGF(2 alpha) concentrations; lung function; clinical symptoms; and dietary intake were measured in 15 cystic fibrosis patients before and after 10-14 d of intravenous antibiotic treatment for a pulmonary exacerbation . RESULTS: After treatment, respiratory status improved (percentage of forced expiratory volume in 1 s: 60 +/- 6% at baseline compared with 74 +/- 7% after treatment, P = 0.01), quality of well-being improved (P = 0.001), and total plasma 8-iso-PGF(2 alpha) concentrations increased from 469 nmol/L at baseline (interquartile range: 373-554 nmol/L) to 565 nmol/L after treatment (interquartile range: 429-689 nmol/L; P = 0.008) . Total energy, fat, carbohydrate, and protein intakes per kilogram body weight also increased; however, dietary antioxidant intake was unchanged . Plasma fatty acid concentrations increased after treatment, strongly correlating with plasma 8-iso-PGF(2 alpha) concentrations (r = 0.768, P = 0.001) . There were no significant changes in white cell counts or plasma concentrations of vitamins E and C or beta-carotene . Erythrocyte glutathione peroxidase activity was reduced after treatment, whereas there was no significant change in superoxide dismutase activity . CONCLUSIONS: Oxidative stress increased after treatment for pulmonary exacerbations and was strongly linked to increased concentrations of plasma fatty acids . Although intravenous antibiotic therapy and physiotherapy improved lung function within 10-14 d of treatment, the biochemical effects of oxidation continued further . Thus, antioxidant intervention during treatment for and recovery from acute infection in cystic fibrosis should be considered.

Thyroid, 2002 Feb, 12(2), 175 - 8
Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis; Fukata S et al.; We report herein an unusual case of thyrotoxicosis caused by acute suppurative thyroiditis (AST) infected through a piriform sinus fistula (PSF) . A 28-year-old man presented with pain over the thyroid gland and elevated serum thyroid hormone levels, a picture similar to subacute thyroiditis . A fine-needle aspiration biopsy from the left lobe showed neutrophil infiltration, and culture from the aspirate grew anaerobic peptostreptococcus . A neck computed tomography (CT) scan showed an abscess in the thyroid gland, and barium swallow revealed the presence of PSF . Appropriate antibiotic treatment ameliorated his symptoms of infection, followed by normalization of thyroid function . Three months later, he underwent fistulectomy and partial left lobectomy . The end of the PSF track was found in the left thyroid lobe . Thus infection of the thyroid gland through the infected PSF was likely the cause of supprative thyroiditis . The unusual clinical features of AST in this patient include the presence of severe thyrotoxicosis, relatively late onset (28-years-old) of infection despite the presence of congenital PSF, and the lack of acute inflammatory signs on the overlying skin of the thyroid gland . It is important to recognize this type of AST, since fistulectomy is required to prevent recurrent AST.

Arch Intern Med, 2002 Mar 25, 162(6), 682 - 8
Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization; Battleman DS et al.; OBJECTIVES: To measure quality-of-care variables relevant to the treatment of community-acquired pneumonia and to determine their relative contribution to variation in length of hospital stay (LOS) . METHODS: One hundred cases of pneumonia requiring hospitalization from each of 7 institutions (2 community and 5 university teaching hospitals) were randomly selected (total sample, 700 cases) . Demographic and clinical variables were abstracted using a standardized data instrument . Three quality-of-care measures were analyzed: (1) site of initial antibiotic treatment (emergency department vs floor), (2) door-to-needle time, and (3) appropriateness of antibiotic selection . Appropriate antibiotic selection was defined by the 1998 Infectious Disease Society of America guidelines for the treatment of hospitalized pneumonia cases . Regression modeling was used to determine associations between LOS and our quality-of-care (process) variables . RESULTS: The mean +/- SD LOS for this sample was 7.0 +/- 4.1 days . Prolonged LOS, defined as greater than or equal to the 75th percentile of the LOS distribution, was the dependent variable in our regression analysis and was greater than or equal to 9.0 days . After clinical and demographic variables were adjusted for, logistic regression modeling revealed that all 3 quality-of-care measures were associated with prolonged LOS: (1) initial antibiotic treatment in the emergency department (odds ratio {OR}, 0.31; 95% confidence interval {CI}, 0.19-0.48); (2) appropriate antibiotic selection (OR, 0.55; 95% CI, 0.35-0.88); and (3) door-to-needle time (OR, 1.75 per 8 hours; 95% CI, 1.34-2.29) . In a secondary analysis, we examined the clinical and demographic characteristics of the patients who were treated more rapidly in the emergency department compared with those who were treated on the inpatient floor . No clinically meaningful differences were observed between these groups . CONCLUSIONS: Unlike clinical and demographic variables, process-of-care variables are modifiable and amenable to quality improvement . We observed that rapid antibiotic initiation and appropriate antibiotic selection in the emergency department have a statistically significant association with shorter LOS . These findings suggest quality improvement targeted at these processes of care may improve resource utilization and reduce LOS for patients with community-acquired pneumonia.

Tunis Med, 2001 Oct, 79(10), 540 - 3
{Brucella endocarditis of native valves . Report of 3 cases}; Lahdhili H et al.; Brucella endocarditis is a rare but a serious complication of human brucellosis . We report 3 cases, the diagnostic was suspected by the patient's history of systemic brucellosis in two cases and established by the culture of native valve material in the third . All the patients underwent surgery for non control of the infections, one patient died in immediately postoperative period by acute cardiac failure . For the other patients, there were no early or late mortality and no recurrence after a follow up of respectively 6 and 84 months . The diagnostic of brucella endocarditis needed a very high degree of clinical suspicion, it requires an early management valve replacement is in the majority of cases, followed by adequate and prolonged antibiotic treatment.

Intensive Care Med, 2002 Feb, 28(2), 154 - 63 Epub 2002 Jan 16.
Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study; Moine P et al.; OBJECTIVE: To evaluate the attributable mortality associated with late-onset nosocomial pneumonia (LOP) while taking into account the severity at admission, the evolution of the patients during the first 4 days after admission to the ICU and the appropriateness of initial empiric antibiotic treatment . DESIGN: Multicenter cohort study with prospective standardization of diagnostic interventions when nosocomial pneumonia develops . SETTING: Medical and surgical ICUs of four university-affiliated teaching hospitals . PATIENTS: Seven hundred sixty-four consecutive patients requiring ICU hospitalization for at least 4 days . MAIN OUTCOME MEASURES: The clinical and biological data as well as the therapeutic data and the outcome were prospectively recorded from the day of admission to ICU discharge . Simplified Acute Physiologic Score (SAPS II) and Logistic Organ Dysfunction (LOD) score were collected and computed within the first 4 calendar days of ICU admission . Variables associated with the outcome were selected using a stepwise Cox model . The time to acquisition of the first LOP was then introduced in the final model as a time-dependent covariate . The analysis was stratified by ICU center . Finally, as initial antibiotic therapy could have an impact on the increased risk of death induced by LOP, the Cox model was applied again introducing LOP immediately adequately treated and LOP not immediately adequately treated as two different time-dependent covariates . RESULTS: Late-onset pneumonia developed in 89 patients (12%) . A McCabe score of more than 1, SAPS II score and increases in SAPS between days 1 and 2, days 2 and 3, and days 3 and 4 were significantly associated with an increased risk of death . When the time to acquisition of the first episode of LOP was introduced into the Cox model, the LOP occurrence was associated with increased mortality, even adjusted over the selected prognostic parameters and after stratification by center (hazard ratio (HR)=1.53, 95% CI 1.02-2.3, p=0.04) . When LOP immediately adequately treated and LOP not immediately adequately treated were separately introduced into the Cox model, inappropriately treated LOP remained significantly associated with an increased risk of mortality (HR=1.69, 95% CI 1.08-2.65, p=0.022), whereas appropriately treated LOP did not (HR=1.44, 95% CI 0.75-2.76, p=0.27) . CONCLUSION: These data suggest that, in addition to severity scores, the underlying medical conditions and the evolution of severity within the first 4 days in ICU, late-onset pneumonia independently contribute to ICU patient mortality when empirical antibiotic treatment is not immediately appropriate.

Circulation, 2002 Mar 19, 105(11), 1298 - 303
Effect of azithromycin treatment on endothelial function in patients with coronary artery disease and evidence of Chlamydia pneumoniae infection; Parchure N et al.; BACKGROUND: It has been suggested that infection with Chlamydia pneumoniae(CPn) can trigger inflammatory mechanisms that may in turn impair vascular endothelial function . The aim of the present study was to assess whether treatment with the macrolide antibiotic azithromycin improves endothelial function in patients with coronary artery disease and antibodies positive to CPn . METHODS AND RESULTS: We carried out a randomized, prospective, double-blind, placebo-controlled trial in 40 male patients (mean age, 55+/-9 years) with documented coronary artery disease and positive CPn-IgG antibody titers . After baseline evaluation, patients were randomized to receive either azithromycin or placebo for 5 weeks . Flow-mediated dilation (FMD) of the brachial artery and E-selectin, von Willebrand factor, and C-reactive protein (CRP) levels were assessed at study entry and at the end of the treatment period . Our results showed that patients who received azithromycin had a significant improvement in FMD (mean change, 2.1+/-1.1%; P<0.005) . In contrast, FMD was not significantly changed in the placebo group (mean change, -0.02+/-0.2%, P=0.64) . Azithromycin therapy also resulted in a significant decrease of E-selectin and von Willebrand factor levels . CRP levels were not significantly altered by treatment with either azithromycin or placebo . Beneficial effects of azithromycin treatment were independent from the presence of low (<1:32) or high (> or =1:32) CPn antibody titers . CONCLUSIONS: Our findings indicate that treatment with azithromycin has a favorable effect on endothelial function in patients with documented coronary artery disease and evidence of CPn infection irrespective of antibody titer levels . Whether these favorable actions of antibiotic treatment will translate into a beneficial effect on atherogenesis and cardiac events needs further investigation.

Blood, 2002 Apr 1, 99(7), 2541 - 4
Molecular follow-up in gastric mucosa-associated lymphoid tissue lymphomas: early analysis of the LY03 cooperative trial; Bertoni F et al.; Gastric marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT)-type can regress after anti-Helicobacter pylori treatment . The International Extranodal Lymphoma Study Group, the United Kingdom Lymphoma Group, and the Groupe d'Etude des Lymphomes de l'Adulte have conducted a trial to ascertain whether the addition of chlorambucil is of benefit after anti-H pylori therapy . At the last interim analysis, 105 (55%) of 189 patients had achieved a complete histologic remission after anti-Helicobacter therapy . To further assess the ability of treatment to eradicate the lymphoma clone, we analyzed the gastric biopsies from a subset of the patients by polymerase chain reaction (PCR) targeted to the immunoglobulin heavy chain genes as a molecular marker for minimal residual disease . Sixty-two cases were examined at diagnosis . Fifty-four cases were monoclonal by PCR . Forty-two of these patients achieved histologic complete remission (hCR) after anti-Helicobacter treatment: 34 cases underwent molecular follow-up analysis . Fifteen patients (44%) were in molecular remission with a median follow-up of 2 years after antibiotic treatment and of 1 year after the achievement of hCR . Less than half of the patients with MALT lymphoma can achieve sustained molecular remission after anti-Helicobacter therapy . The presence of molecular disease in the absence of histologic disease does not appear to be associated with histologic relapse, but, given the indolent nature of MALT lymphomas, a longer follow-up is needed.

J Chemother, 2002 Feb, 14(1), 88 - 91
Brucellosis in the etiology of febrile neutropenia: case report; Sari R et al.; Brucellosis is one of the leading diseases in the differential diagnosis of fever of unknown origin in some parts of the world . It can lead to treatment failure because of slow growth in blood cultures and late appearance of signs and symptoms in patients with febrile neutropenia who were unresponsive to empirical antibiotic treatment . During the last year in our oncology unit adjuvant chemotherapy was given to 3 patients with breast (n=1) and stomach cancer (n=2) and febrile neutropenia was seen after the first course of chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, etoposide, Adriamycin, and cisplatin) in all 3 patients . Cefepime and amikacin were commenced but the fever continued . Prior to antifungal treatment, the patients were re-evaluated because of the history of unpasteurized milk ingestion without overt signs and symptoms . Serum agglutination tests of brucellosis were performed and were 1:640 in two patients and 1:320 in the third . Brucella melitensis was identified only in one case although multiple blood cultures were taken from all 3 patients . Empiric antibiotic treatment was stopped and streptomycin 1 g/day (10 days), doxycycline 200 mg/day (28 days), trimethoprim 320 mg and sulfamethoxazole 1600 mg/day (28 days) were given . Although neutropenia continued, fever subsided in 3 days . Due to high incidence of brucellosis in some geographic areas, especially in the Middle East, brucellosis should be kept in mind in the differential diagnosis of febrile neutropenia.

Expert Opin Biol Ther, 2002 Mar, 2(3), 279 - 86
Immunomodulators in the treatment of cutaneous lymphomas; Dummer R; Cutaneous lymphomas (CLs) are a heterogeneous group of lymphoproliferative cutaneous neoplasms that in many cases cannot be cured by standard radio- and chemotherapy . Immunotherapy holds promise for a well-tolerated treatment approach that allows long-time disease control . Unspecific immunotherapy such as IFNs is successfully used in cutaneous T-cell lymphomas (CTCLs) . Antibiotic treatment is often effective in cutaneous B-cell lymphomas (CBCLs) . New treatment approaches include fusion toxins and chimeric monoclonal antibodies (mAbs) such as rituximab for CBCLs . The identification of tumour antigens in CTCLs renders these diseases susceptible for vaccination approaches.

Bull Soc Pathol Exot, 2001 Dec, 94(5), 394 - 6
{Leptospirosis in children of Libreville: difficult diagnosis, apropos of 1 case}; Koko J et al.; Leptospirosis is a widespread zoonosis, which is diagnosed less frequently in children than might be expected from the level of exposure to hazards, especially in tropical areas . A 15 1/2-year-old Gabonese boy was admitted following five days of fever, headache, myalgia, abdominal pain, diarrhea, intestinal bleeding, jaundice and conjunctival suffusion . Laboratory data showed abnormal liver and renal function tests, and diagnosis of Plasmodium falciparum malaria was confirmed by thin blood smear . The patient did not clinically improve despite antimalarial treatment and then leptospirosis was suspected . Serologic tests were performed and leptospirosis was later confirmed . Antibiotic treatment (cefuroxim) was given . The outcome was good, liver and renal tests returned to normal in a few days . In tropical area, leptospirosis should be considered in children who are diagnosed with either an unexplained fever, a pseudo-influenza syndrome, or jaundice with hepatorenal involvement and gastrointestinal bleeding.

Gut, 2002 Apr, 50(4), 460 - 4
Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects; Higham J et al.; BACKGROUND: Although overall admission rates for peptic ulcer in England declined from the 1950s up until the mid 1980s, perforations among older women increased, possibly due to increasing use of non-steroidal anti-inflammatory drugs (NSAID) . Since then, proton pump inhibitors, antibiotic treatment for Helicobacter pylori, low dose aspirin, and selective serotonin reuptake inhibitors (SSRI) have been introduced Aims: To determine time trends for hospital admissions for peptic ulcer from 1989 to 1999 (England), mortality from 1958 to 1998 (England and Wales), and prescriptions for ulcer healing drugs, aspirin, NSAID, oral anticoagulants, and SSRI from 1990 to 1999 (England) . METHODS: Hospital episode statistics for admissions and mortality were obtained from the Office of National Statistics: community prescription data from Statistics Division 1E of the Department of Health . RESULTS: Between 1989/90 and 1998/99, there was a marked rise in admissions for haemorrhage in older patients, particularly from duodenal ulcer . Perforations from gastric ulcer declined but perforations from duodenal ulcer increased among men at older ages . Since the mid 1980s mortality has declined in all age groups except for older women with duodenal ulcer . The number of prescriptions for histamine H(2) receptor antagonists remained constant but those for proton pump inhibitors increased by 5000%, aspirin 75mg by 460%, oral anticoagulants by 200%, and NSAID by 13% between 1990 and 1999 . Since the introduction of SSRI in 1991, prescriptions have increased 15-fold . CONCLUSIONS: Admission rates for gastric and duodenal ulcer haemorrhage and duodenal ulcer, but not gastric ulcer perforation, increased among older subjects, over a time when prescriptions for proton pump inhibitors, low dose aspirin, oral anticoagulants, and SSRI increased.

Chest, 2002 Mar, 121(3), 836 - 40
Short-term course and outcome of treatments of pleural empyema in pediatric patients: repeated ultrasound-guided needle thoracocentesis vs chest tube drainage; Shoseyov D et al.; BACKGROUND: Several reports have suggested that early chest tube drainage (CTD) may not be necessary in the treatment of severe pleural empyema (PE) in pediatric patients if appropriate antibiotic therapy and supportive care are provided . OBJECTIVES: A prospective open study to compare the short-term course of two treatment protocols of severe PE in pediatric patients . STUDY DESIGN: One group of 32 patients was treated with early insertion of a chest tube for CTD, and a second group of 35 patients was treated by a repeated ultrasound-guided needle thoracocentesis (RUSGT) . The severity of the empyema was assessed by chest radiograph, the amount of fluid drained, the number of days the patient had experienced a fever, and the duration of antibiotic treatment . RESULTS: No significant differences were found between the two groups (RUSGT vs CTD) in all of the following measurements: mean (plus minus SD) duration of a temperature > or = 39 degreesC, 6.2 +/- 2.4 vs 6.5 +/- 1.8 days, respectively; mean duration of a temperature > or = 38 degreesC, 9 +/- 3.9 vs 8.2 +/- 4.5 days, respectively; fluid drained, 35.1 + 23.8 vs 30 +/- 28.2 mL/kg, respectively; duration of antibiotic treatment, 30 +/- 13.2 vs 30.2 +/- 7.3 days, respectively; and length of hospitalization and home IV treatment, 22 +/- 7.6 vs 24.2 +/- 7.5 days, respectively . A failure to respond to treatment occurred in three patients in the RUSGT-treated group and in five patients in the CTD-treated group . The failure to respond occurred in the RUSGT-treated group only in those patients with very large empyemas that caused mediastinal deviation . CONCLUSION: The treatment of PE by RUSGT is as efficacious as CTD, unless PE causes mediastinal deviation.

Acta Vet Scand, 2001, 42(3), 339 - 46
The effect of two different oxytetracycline treatments in experimental Ehrlichia phagocytophila infected lambs; Stuen S et al.; The effect of 2 different oxytetracycline treatments in acute E . phagocytophila infected lambs was investigated . Twenty 5-month-old lambs of the Dala and Rygja breeds were used . Ten lambs were inoculated intravenously with a stabilate of an ovine E . phagocytophila strain . On the third day of fever, 4 lambs were given long-acting oxytetracycline (Terramycin prolongatum vet, Pfizer) (20 mg/kg) intramuscularly and another 4 lambs were given short-acting oxytetracycline (Terramycin vet, Pfizer) (10 mg/kg) intravenously for 5 consecutive days . The lambs were examined for the presence of Ehrlichia infection by blood smear evaluation, polymerase chain reaction (PCR) and antibody titre against E . equi . One month after the last antibiotic treatment, 250 ml citrate blood from each of these lambs were inoculated into each of 10 susceptible lambs, which were observed during the following 6 weeks . The results indicate that oxytetracycline given in the acute stage of the infection may effectively terminate the development of fever, rickettsemia and weight reduction in E . phagocytophila infected lambs . No difference was observed between the 2 treatment groups . However, at least 3 of 8 antibiotic treated lambs (37.5%) were still infected with granulocytic Ehrlichia 3 months after treatment.

Int J STD AIDS, 2002 Apr, 13(4), 264 - 7
A multidistrict audit of the management of chlamydial PID in genitourinary medicine clinics in Yorkshire; Kuchimanchi U et al.; In response to recent reviews of practice of pelvic inflammatory disease (PID) management, a multidistrict audit involving eight genitourinary clinics within the Yorkshire region was carried out . This audit reports the referral patterns of patients, physical signs and microscopy findings at the first genitourinary medicine (GUM) clinic attendance, antibiotic treatment and follow-up data as well as health adviser involvement and partner participation for 68 patients diagnosed with chlamydial PID . Twenty-eight (41.2%) patients presented with symptoms of less than or equal to four weeks duration, partner notification was recorded as being carried out for all patients and at least one partner was documented as having been treated in 57 (83.8%) patients . There is, however, a wide variation in the antibiotic regimens used for treatment and their duration.

Reprod Domest Anim, 2001 Oct, 36(5), 244 - 6
Combined gnRH and PGF2alpha application in cows with endometritis puerperalis treated with antibiotics; Janowski T et al.; The investigations were carried out on a total of 70 cows with puerperal endometritis . In addition to intrauterine antibiotic treatment, 30 experimental animals were administered 20 microg GnRH analogue, buserelin, between days 10 and 12 post-partum followed by 500 microg PGF2alpha analogue, cloprostenol, 10 days later . Forty control cows were treated only with intrauterine antibiotics . Blood samples for progesterone determination were collected from the tail vein twice weekly until day 70 post-partum . The first rise in progesterone level above 3.18 nmol/l occurred significantly earlier in the experimental than in control cows (21.6 +/- 9.2 versus 27.8 +/- 12.3 days; p < or = 0.05) . The duration of the first cycle post-partum was 15.0 +/- 4.3 days in experimental and 19.7 +/- 7.3 days in control animals (p < or = 0.05) . However, no significant differences were observed in the occurrence of first oestrus post-partum . The involution of the uterus was improved after hormone treatment . At day 42 post-partum, completion of uterine involution was found in 93.3% of hormone-treated cows and in 82.5% of those treated with antibiotic only (p < or = 0.05) . Clinical recovery was 96.6% in the experimental and 82.5% in the control group (p < or = 0.05) . First service pregnancy rate was significantly better in hormone-treated than control cows (51.7 versus 36.4%; p < or = 0.05) . Total pregnancy rate and insemination index values were not significantly improved following GnRH and PGF2alpha treatment . The average service period was 89.8 +/- 21.2 days in cows after hormone treatment, and 112.6 +/- 24.5 days in control cows . The difference was statistically significant (p < or = 0.05) . These results indicate, that the sequential GnRH and PGF2alpha application in cows with puerperal endometritis positively affected ovarian function and uterine involution, resulting in improved fertility performance.

Ann Periodontol, 2000 Dec, 5(1), 137 - 51
Factors associated with radiographic vertical bone loss around implants placed in a clinical study; Manz MC; The loss of vertical bone height over time has been assessed radiographically as part of the Dental Implant Clinical Research Group studies . Radiographs were assessed from implant placement, uncovering surgeries, and recall appointments . Overall, the study implants experienced most peri-implant vertical bone loss in the first year after placement, followed by a dramatic decrease in bone loss rate through the subsequent study intervals . Stratified analysis of data up to 72 months after implant uncovering indicates different bone loss patterns by: 1) arch; 2) jaw region; 3) case type; 4) bone quality; 5) surface type; 6) implant design; 7) smoking status; and 8) postoperative antibiotic treatment . These results will be used to build statistical mixed models to indicate which clinical factors are most predictive of peri-implant vertical bone loss, controlling for confounding and accounting for correlation of data over time and within study patients.

Infection, 2002 Jan, 30(1), 17 - 21
Short courses of intravenous empirical antibiotic treatment in selected febrile neutropenic children with cancer; Lehrnbecher T et al.; BACKGROUND: Since the optimal duration of antibiotic therapy in febrile neutropenic patients is not clear, we evaluated the safety and efficacy of short courses of intravenous antibiotic treatment in selected pediatric cancer patients admitted for fever and neutropenia . PATIENTS AND METHODS: We retrospectively analyzed the clinical course of children with chemotherapy-induced neutropenia and fever . All patients were treated with empirical intravenous antibiotics . In episodes of fever of unknown origin (FUO), treatment regimen allowed discontinuation of antibiotics and early hospital discharge regardless of absolute neutrophil count (ANC) or evidence of bone marrow recovery as long as patients were afebrile for at least 24 h and had been treated for a minimum of 72 h . RESULTS: 106 episodes of febrile neutropenia occurred in 56 patients . 84 episodes were classified as FUO and intravenous antibiotic therapy was discontinued regardless of ANC when patients met the criteria described above . No death or major complication occurred . None of the patients had to be rehospitalized for recurrent fever or infection . CONCLUSION: Discontinuation of intravenous antibiotics regardless of ANC or evidence of bone marrow recovery seems safe and effective in pediatric cancer patients with FUO when children are afebrile for at least 24 h and are treated for a minimum of 72 h.

Pediatrics . 2002 Mar;109(3):E44.
Increased activity of lysosomal enzymes in the peritoneal fluid of bacterial peritonitis; Beratis NG et al.; OBJECTIVE: The activity of lysosomal enzymes is increased in the cerebrospinal fluid of bacterial meningitis, suggesting that inflammation may cause leakage of lysosomal enzymes into the extracellular fluid . Our objective was to study the activity of 3 lysosomal enzymes in cell-free peritoneal fluid of patients with peritoneal inflammation . METHODS: The beta-galactosidase, beta-glucuronidase, and alpha-mannosidase activity (nmol 4-methylumbelliferone/mL/h); the total, polymorphonuclear, and mononuclear cell number; and chemical parameters were determined in the peritoneal fluid of 26 patients with culture-positive acute bacterial peritonitis, 13 patients (under antibiotic treatment) with culture-negative bacterial peritonitis, 6 patients with acute mesenteric lymphadenitis, and 26 control subjects who were operated on for surgical conditions without peritoneal inflammation . RESULTS: The median beta-galactosidase activity in the culture-positive bacterial peritonitis, mesenteric lymphadenitis, and controls was 175 (range: 63--2210), 50 (range: 37--56), and 16 (range: 8--32), respectively . The beta-glucuronidase was 488 (range: 79--998), 53 (range: 27--98), and 15 (range: 3--22), respectively . The alpha-mannosidase was 801 (range: 100-3172), 78 (range: 33--157), and 41 (range: 16--63), respectively . The differences of the enzyme activities among the groups of the subjects studied were significant, with the exception of the alpha-mannosidase activity between mesenteric lymphadenitis and controls . There was no significant correlation between the enzyme activities and the cytologic or chemical parameters studied . CONCLUSIONS: The elevation of the lysosomal enzymes' activity in the peritoneal fluid of patients with bacterial peritonitis seems to be a reliable index of peritoneal infection . Of the enzymes studied, the beta-glucuronidase and beta-galactosidase activities provide the best means for diagnosing bacterial inflammation of the peritoneal cavity.

Cochrane Database Syst Rev . 2002;(1):CD002218.
Antibiotics versus control for toxoplasma retinochoroiditis; Gilbert RE et al.; BACKGROUND: Acute toxoplasma retinochoroiditis causes transient symptoms of ocular discomfort and may lead to permanent visual loss . Antibiotic treatment primarily aims to reduce the risk of permanent visual loss, recurrent retinochoroiditis, and the severity and duration of acute symptoms . There is uncertainty about the effectiveness of antibiotic treatment . OBJECTIVES: The objective of this review was to compare the effects of antibiotics versus placebo or no treatment for toxoplasma retinochoroiditis . SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group Specialised Register (Cochrane Library Issue 2, 2001), MEDLINE (1966 to August 2001), EMBASE (1980 to September 2001), Dissertation Abstracts (1861 to June 2001), LILACS (1982 to 1998), Pascal (1984 to March 2000), proceedings of the Association for Research in Vision and Ophthalmology (1980 to 2001), international symposia on uveitis, and reference lists of review articles . Pharmaceutical companies were contacted for unpublished trials . SELECTION CRITERIA: We included randomised controlled trials that compared any systemic antibiotic treatment against placebo or no treatment . Trials that included immunocompromised patients were excluded . DATA COLLECTION AND ANALYSIS: The primary outcomes for this review were visual acuity at least three months after treatment and risk of recurrent retinochoroiditis . Secondary outcomes were improvement in symptoms and signs of intraocular inflammation, size of lesion and adverse events . Effect measures were pooled using a random effects model . MAIN RESULTS: Three trials, which randomised a total of 173 participants, met the inclusion criteria . All trials were methodologically poor . None reported the effect of treatment on visual acuity . Two studies reported results for recurrent retinochoroiditis: one (124 participants) found a significant reduction in participants with chronic recurrent disease who were treated for 14 months: relative risk 0.28 (95% confidence interval 0.10 to 0.78); the other (20 participants) found no evidence of an effect in participants with acute toxoplasma retinochoroiditis (relative risk 1.00, 95% confidence interval 0.07 to 13.87) . Two studies reported an improvement in intraocular inflammation in treated compared with untreated participants and one study reported no difference . Two studies found an increased risk of adverse events in treated participants . REVIEWER'S CONCLUSIONS: There is a lack of evidence to support routine antibiotic treatment for acute toxoplasma retinochoroiditis . There is weak evidence to suggest that long-term treatment of patients with chronic recurrent toxoplasma retinochoroiditis may reduce recurrence . Placebo controlled trials of patients with acute and chronic toxoplasma retinochoroiditis affecting any part of the retina are required to determine the effectiveness of antibiotic treatment.

Clin Microbiol Infect, 1998 Jan, 4 Suppl 4, S7 - S13
Diagnosis of Chlamydia pneumoniae; Saikku P; This paper considers the use of diagnostic techniques for Chlamydia pneumoniae in both acute and chronic infections, together with the detection of upper respiratory tract carriage . It is concluded that such diagnosis is still unsatisfactory, although techniques for acute infection are more reliable than those for chronic conditions . Reliable and inexpensive methods, particularly for the diagnosis of chronic C . pneumoniae infection, are urgently needed, if only because of the recent demonstration of the beneficial effects of antibiotic treatment in patients with atherosclerosis carrying markers for the presence of this organism.

Clin Microbiol Infect, 1997 Jun, 3 Suppl 3, S13 - S22
Incidence and risk factors of acute otitis media in children; Baraibar R; Acute otitis media (AOM) is the most common disease requiring antibiotic treatment in young children . This article reviews the incidence of AOM in different age groups of controlled populations, its incidence in pediatricians, consulting rooms and emergency services and the main circumstances that usually complicate the diagnosis (circumstances of examination, methods and devices used and pediatric skills) . Host and environmental factors related to otitis- prone children are revisited . Sex predominance (males), ethnicity, birth order (second-born or siblings), early occurrence of infection (when earlier, worse), and sibling history of severe or recurrent ear infections are host factors related to recurrent otitis . Season (inconclusive), socio-economic status (inconclusive) smoke and air pollutants (clearly related), breast-feeding (clearly related, especially when prolonged) and type of day care (the greatest incidence in children in large day-care groups versus home-cared) are environmental factors related to recurrent otitis.

Thorax, 2002 Mar, 57(3), 267 - 71
The pulmonary physician in critical care . 3: critical care management of community acquired pneumonia; Baudouin SV; Severe community acquired pneumonia carries a high mortality . Early recognition of the severity of the illness, rapid and appropriate resuscitation, targeted antibiotic treatment, and the critical care support of multiple failing organ systems are all important in this group of patients . Only by improving all these aspects of care is it likely that survival will increase.

Clin Microbiol Infect, 1996 Aug, 2(1), 25 - 29
IgG avidity in the serodiagnosis of acute Toxoplasma gondii infection: a multicenter study; Sensini A et al.; OBJECTIVE: To evaluate the validity of the IgG avidity test in the serodiagnosis of acute T . gondii infection; to verify the maturation of IgG avidity during the course of infection; to observe whether the kinetics of IgG maturation could be affected by antibiotic treatment . METHODS: Serial serum samples, collected in three Italian hospitals (Perugia, Treviso and Bologna), from untreated and antibiotic-treated patients with primary toxoplasmic infection, were assayed for IgG avidity, and IgM and IgA positivity . Single serum samples from patients at different stages of infection were assayed for IgG avidity and the results were correlated to the likely stage of infection . RESULTS: The IgG avidity value increased from 3.5% in the first month to 38.7% 1 year from the onset of infection . Antibiotic-treated patients showed significantly different values of IgG avidity at 2 and 4 months after the onset of infection . In single serum samples the IgG avidity values correlated with the likely stage of infection . CONCLUSIONS: The IgG avidity test was confirmed as a useful tool in the serodiagnosis of acute T . gondii infection and could be predictive of the stage of infection . Antibiotic treatment may affect the kinetics of the maturation of IgG avidity.

Expert Opin Pharmacother, 2002 Mar, 3(3), 271 - 5
Cost-effectiveness of antibiotic prophylaxis for bacterial arthritis; van Schaardenburg D et al.; The outcome of bacterial arthritis is generally poor: the mortality is 10 - 15% and there is loss of joint function in 25 - 50% of the survivors . The incidence of bacterial arthritis is low: 2 - 6 cases per 100,000 people per year . Risk factors are age, joint disease (especially rheumatoid arthritis {RA}), diabetes mellitus and the presence of a prosthetic joint . The predominant situations that can lead to bacterial arthritis are skin infections of the feet and rarely invasive medical or dental procedures . Due to the severity of the disease, antibiotic prophylaxis of haematogenous bacterial arthritis in patients with prosthetic joints is advocated . However, due to the rarity of the disease it is unclear whether the advantages of prophylaxis outweigh the disadvantages of the large-scale use of antibiotics, such as side effects, costs and bacterial resistance . In a decision-analysis of a large group of patients with joint diseases, antibiotic treatment of skin infections appeared to be cost-effective in the prevention of haematogenous bacterial arthritis, mainly in high-risk patients . On the other hand, prophylaxis around medical or dental procedures was not cost-effective, except possibly in a small group of patients with increased risk.

Br J Ophthalmol, 2002 Mar, 86(3), 339 - 43
Longitudinal study of trachomatous trichiasis in the Gambia; Bowman RJ et al.; AIM: Investigation of the natural history of trachomatous trichiasis in the Gambia and of the outcome of self epilation and surgery for the condition . METHODS: A 1 year longitudinal study of 190 subjects with trichiasis was performed . Major trichiasis cases (five lashes or more) were referred for surgery and minor trichiasis cases were advised to epilate . Outcome measures included progression of trichiasis and corneal scarring; attendance for and results of surgery . RESULTS: 34 of 148 (23%, 95% CI 16 to 31) subjects with major trichiasis attended for surgery over the year . Progression from minor to major trichiasis occurred in 18 of 55 subjects (33%, 95% CI 21 to 47) . Progression of corneal scarring occurred in 60 of 167 patients (36%, 95% CI 29 to 44) . Clinically active trachoma and conjunctival bacterial isolation predicted progression of corneal opacity . Surgery was successful in 39 of 54 (72%) eyes . CONCLUSIONS: Despite the overall decline in trachoma in the Gambia, patients with both minor and major trichiasis remain at risk of developing corneal opacity . Active trachomatous inflammation and additional infection with bacteria may accelerate this process . Antibiotic treatment for trichiasis patients (in addition to surgery) should be investigated . Surgery for minor trichiasis may be indicated . Regular audit of surgical results is necessary with retraining where needed.

Clin Microbiol Infect, 1997 Feb, 3(1), 41 - 44
Early Lyme disease: Humoral immune status and treatment; Karaivanova LA et al.; OBJECTIVE: To investigate the humoral immune status and the effect of antibiotic treatment in Bulgarian patients with early Lyme disease . METHODS: A total of 34 early Lyme disease patients was examined, 16 with erythema migrans and 18 with non-specific systemic symptoms . Serum samples from all patients and from 12 healthy controls were tested for total immunoglobulins (IgG, IgA and IgM), hemolytic activity of complement (CH50) and immune complexes (ICs) . The patients were treated with doxycycline (100 mg orally, twice daily for 10 to 15 days, in one or two courses) . RESULTS: The patients showed significantly increased IC levels (P<0.01 for patients with erythema migrans and P<0.001 for patients with non-specific symptoms) . There were no significant changes in the levels of total hemolytic complement and total immunoglobulins (IgG, IgA and IgM) . The clinical outcome was satisfactory in 21 of the 34 patients (61.8%) after treatment with doxycycline for 10 to 15 days . The rest of the patients (38.2%) failed to respond to the therapy, and continued to report various complaints, such as arthralgia, myalgia, paresthesia, headache, fatigue or recurrent rash . All of these had elevated levels of IC . After a second course of treatment with the same antibiotic regimen these patients had resolution of symptoms (12 patients) or improvement (1 patient) . CONCLUSIONS: Immunologic investigation may be useful in determining treatment strategy in Lyme disease . Elevated IC levels may indicate a need for more prolonged antibiotic therapy.

Angiology, 2002 Jan-Feb, 53(1), 49 - 55
Stenotrophomonas maltophilia endocarditis: a systematic review; Khan IA et al.; The disease characteristics, management, and outcome of Stenotrophomonas maltophilia endocarditis were evaluated by examining the reports on the subject identified through a comprehensive literature search . Twenty-three (17 male) cases of S. . maltophilia endocarditis were identified . Mean age was 41 +/- 15 years . All patients presented with fever . Prosthetic valves were involved in 12 (52%) cases . Among native valves, the aortic valve was most frequently involved (50%), followed by the tricuspid valve (36%) . Twenty (87%) patients had underlying risk factors for the development of endocarditis, including prior valvular or congenital heart disease surgery (60%), intravenous drug abuse (32%), and infected intravascular lines (18%) . The endocarditis was postoperative in 14 patients . Seventeen (74%) patients experienced complications including septic embolism (23%), cardiac abscesses (23%), and congestive heart failure (18%) . A combination of two or more antibiotics was used in all cases except one . The frequently used antibiotics were aminoglycosides (59%), trimethoprim-sulfamethoxazole (48%), and penicillins (48%) . One half of the patients required cardiac surgery, but the proportion of surgically treated cases was higher among prosthetic valve endocarditis (62%) . Mortality was 39% and was equally distributed between patients with prosthetic and native valve endocarditis . The S . maltophilia endocarditis carries high complication and mortality rates . The antibiotic regimen should consist of a combination of multiple antibiotics guided by the sensitivity panel . Early surgery may be considered in patients not responding to antibiotic treatment and in those with prosthetic valve endocarditis.

Cornea, 2002 Mar, 21(2), 230 - 1
More than tears in your eyes (Exophiala jeanselmei keratitis); Ben-Simon GJ et al.; PURPOSE: To describe a patient with Exophiala jeanselmei keratitis . METHODS . CASE REPORT: One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice . RESULTS: Culture plates from corneal scraping showed a growth of the yeast Exophiala jeanselmei, a rare causative agent of ocular infection . CONCLUSIONS: Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma . If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.

Gastroenterol Clin Biol, 2001 Oct, 25(10), 908 - 11
{Colonic actinomycosis . Clinical, endoscopic and histological aspects in one patient}; Vialle R et al.; Colonic location of actinomycosis must be distinguished from infected colonic carcinoma and other colonic inflammatory pseudotumors . The diagnosis is often made by histological examination of the tumor . Initial treatment consists in surgery, followed by an antibiotic treatment . We report the case of a 32-year old woman with a right colonic actinomycosis.

Gastroenterol Clin Biol, 2001 Oct, 25(10), 891 - 5
{Malnutrition is an independent risk factor of early complications following percutaneous endoscopic gastrostomy}; Beau P et al.; BACKGROUND: The relationship between malnutrition and complications occuring in hospitalized patients is debated.AIM: To assess prospectively the relationship between nutritional status and percutaneous endoscopic gastrostomy (PEG)-related complications and to determine the respective role of malnutrition and confounding variables on clinical outcome.METHODS: Ninety seven patients were followed up for 30 days after PEG insertion and complications were prospectively recorded . Patients were classified as malnourished when they met one of the following criteria: body mass index<20 kg/m(2) and/or weight loss > 5% . Multivariate logistic regression analysis was used to adjust for age, sex, diagnoses, functional status, antibiotic treatment and duration of hospital stay before PEG insertion.RESULTS: Sixty eight (70.1%) patients were malnourished . A significantly higher number of complications was seen in malnourished than in non malnourished patients (54.4% vs 31%; odds-ratio (OR): 2.65 {CI 95%: 1.06-6.66}; P=0.04) . One-month mortality did not significantly differ between malnourished and non malnourished patients . Multivariate analysis showed that malnutrition (OR: 3.15 {1.21-8.24}; P=0.02) and > 10-day hospital stay (OR: 2.77 {1.13-6.82}; P=0.03) were significantly associated with early complications.CONCLUSION: These data suggest that malnutrition increases the risk of early complications after PEG insertion, independently of the underlying diseases and functional status of the patients.

Bone Marrow Transplant, 2002 Jan, 29(2), 129 - 36
Renal function after autologous bone marrow transplantation in children: a long-term prospective study; Frisk P et al.; We measured glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and the concentrating capacity of the kidneys in children after autologous BMT . Twenty-six patients had received TBI in their conditioning regimen and 14 patients had received chemotherapy only . Median follow-up was 10 years . Mean GFR before BMT was close to normal in both groups . Mean GFR decreased from 124 {CI 114,134} ml/min/1.73 m(2) before BMT to 99 {CI 82,115} ml/min/1.73 m(2) 6 months after BMT in the + TBI group (P < 0.001) . There was no significant change in the -TBI group . Mean ERPF before BMT was high: 1110 {95% CI 830,1390} ml/min/1.73 m(2) in the + TBI group and 910 {CI 570,1250} ml/min/1.73 m(2) in the - TBI group . Six months after BMT, there was a tendency to a decrease in ERPF in the +TBI group, to 760 {CI 580,940} ml/min/1.73 m(2) (P = 0.064) . After this initial decrease, GFR and ERPF remained essentially unchanged in both groups . The mean concentrating capacity of the kidneys was normal before and after BMT . In seven patients chronic renal impairment developed after BMT (GFR <70 ml/min/1.73 m(2)) . All had received TBI . They had also received more nephrotoxic antibiotics than the other patients . We conclude that TBI was the principal cause of deterioration of renal function after BMT, possibly by limiting compensatory hyperperfusion and resulting in a fall in GFR . Antibiotic treatment may have contributed.

Hong Kong Med J, 1997 Mar, 3(1), 21 - 26
A three-year review of treatment of cervical intraepithelial neoplasia with large loop excision of the transformation zone; Chan KS et al.; One hundred and eighty-five patients were treated with large loop excision of the transformation zone for cervical intraepithelial neoplasia from October 1992 through September 1994 . All patients were followed up regularly until September 1995 to review the outcome and morbidity . Cure rates of 97.2% in the first six months and 95.4% at the end of the first 12 months were obtained . Thirteen patients (7.0%) were admitted as emergency cases for post-operative haemorrhage, which required suturing, cauterisation with silver nitrate or electrocoagulation, vaginal douching, or antibiotic treatment . One patient developed cervical stenosis and incomplete excisions were noted in 46 (24.9%) patients . Eleven (6.0%) patients had cervical carcinomas detected . Our findings further confirm that this method is a reliable and safe way to treat cervical intraepithelial neoplasia with an acceptable rate of morbidity.

Rev Prat, 2001 Dec 1, 51(19), 2081 - 5
{Bacterial perihepatitis}; Parolini I et al.; The Fitz-Hugh-Curtis syndrome is a peri-hepatitis following a genital infection . It usually occurs in young women . Chlamydia trachomatis is the most frequent causal agent . Clinical signs include acute or recurrent pain in the right hypochondria . Liver tests are not modified and the sonographic examination is normal . Diagnosis can be suspected on the basis of serology, and formally established by laparoscopy showing violin string-like adhesions . Prolonged antibiotic treatment is effective.

Leukemia, 2002 Feb, 16(2), 284 - 8
Elimination of mycoplasma from leukemia-lymphoma cell lines using antibiotics; Uphoff CC et al.; Mycoplasmal contamination of cell culture systems continues to present major problems for basic research and for manufacturing of bioproducts . Previous work suggested that certain antibiotics have strong anti-mycoplasma properties and raised the prospect that the technically rather simple antibiotic treatment may be an appropriate means for mycoplasma eradication . We have developed and validated an effective strategy to eliminate mycoplasma from chronically infected cell cultures using antibiotics which have shown strong activity against these contaminants . Here, we describe our experience with the treatment of 123 consecutive mycoplasma-positive leukemia-lymphoma cell lines, comparing five different antibiotic regimens (in total 433 treatments) . We optimized the antibiotic dose schedules and the duration of treatments . The various antibiotic treatments which were employed in parallel had a high efficacy, as 71% to 86% of the infected cultures were cleansed . Treatment failure may result from the resistance of the mycoplasmas to antibiotic therapy and the inability of the eukaryotic cells to survive the cytotoxic effects of the antibiotics . Resistance to mycoplasma eradication was observed in 3% to 20% of the cultures . Loss of the cell culture caused by cytotoxicity was seen in 3% to 11% of the treatments . With regard to the overall outcome, 96% of the cell lines were rendered mycoplasma-free with at least one of the antibiotic treatments and were permanently cured . In conclusion, antibiotic treatment represents the most practical and efficient option to cleanse mycoplasma-positive cell lines.

Expert Opin Pharmacother, 2002 Feb, 3(2), 113 - 20
Azithromycin for the treatment and control of trachoma; Burton MJ et al.; Trachoma, a recurrent follicular conjunctivitis caused by Chlamydia trachomatis, is the leading cause of preventable blindness worldwide . Efforts to control this disease have met with limited success . This failure is due in part to the limitations of conventional antibiotic treatment, a prolonged course of topical tetracycline . Azithromycin, an azalide antibiotic, is effective against chlamydial infections when given as a single oral dose . Recent research from Africa has shown azithromycin to be as effective as tetracycline in the treatment of trachoma . Under operational conditions azithromycin proved to be more effective . This success is attributed to a much-improved compliance with treatment . Community-wide mass treatment with azithromycin is advocated as a means of controlling trachoma in endemic countries . Questions still remain over the use of azithromycin for this purpose . The frequency and target population of mass distribution campaigns need to be defined . A few countries are beneficiaries of a philanthropic donation by the manufacturer of azithromycin, Pfizer Inc . However, in the absence of a drug donation programme the cost-effectiveness of this measure is unclear.

Zhonghua Wai Ke Za Zhi, 1998 Aug, 36(8), 464 - 5
{Surgical treatment of infective endocarditis}; Xu S et al.; OBJECTIVE: To summarize the experience of surgical treatment of infective endocarditis in 28 patients . METHOD: Open heart surgery under cardiopulmonary bypass was performed in all patients: valve replacement (24), VSD repair and tricuspid annuloplasty (3), and Bentall (1) 17 mechanical and 7 homograft valves were placed . RESULT: Two died in hospital, 4 died from infection, 1 had periprosthetic leakage and incompetence respectively . 22 survivors showed improved heart function . CONCLUSION: Combined medication and surgical treatment is superior to antibiotic treatment in long-term survival and convalescence . Infective reccurrence, reinfection and advanced heart failure are major risk factors after operation.

Chir Ital, 2001 Nov-Dec, 53(6), 905 - 8
{Fournier's gangrene in a patient with Hodgkin's disease: a clinical case}; Castellini C et al.; The authors report a case of Fournier's gangrene in a 54-year-old patient subjected 6 days earlier to chemotherapy for mediastinal Hodgkin's disease . The patient had fever and reported the onset of worsening pain and heat sensations in the inguinal, perineal and scrotal areas . Objectively, there was local oedema followed by the onset of crepitation . The patient had a very low white blood cell count (900/cu.mm) . The Patient underwent emergency surgery with multiple, communicating incisions in the inguinal, perineal and scrotal areas, with the removal of necrotic tissue and daily washing with physiological solution and 12% H2O2 . He also received antibiotic treatment with metronidazole and gentamicin and 5 cycles of high-pressure oxygen therapy, with disappearance of pain and fever and good local tissue repair.

Chirurg, 2001 Dec, 72(12), 1413 - 6
{Surgical treatment of axillary hidradenitis suppurativa}; Altmann S et al.; INTRODUCTION: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas and abscesses, mostly located in the groin and axillary regions . A conservative treatment can not prevent a recurrence . PATIENTS AND METHODS: We report on 16 patients with axillary hidradenitis suppurativa . The inflammatory region was excised, followed by immediate coverage with a transposition flap according to Limberg . Postoperatively, all patients received antibiotic treatment . After 2 weeks, physiotherapy was begun . RESULTS: All wounds healed primarily . Functional and aesthetic results were very satisfactory . Movement of the shoulder showed no restrictions . There was no major complication . The recurrence rate was low . DISCUSSION: Only radical debridement prevents a recurrence . The therapy of choice is radical excision of the affected region and immediate coverage by a transposition flap . Open granulation or split-skin grafting are inferior compared with a primary closure by transposition flap . Using the Limberg flap the donor site can be closed primarily.

Trends Neurosci, 2002 Jan, 25(1), 38 - 45
Neuronal injury in bacterial meningitis: mechanisms and implications for therapy; Nau R et al.; In bacterial meningitis, long-term neurological sequelae and death are caused jointly by several factors: (1) the systemic inflammatory response of the host, leading to leukocyte extravasation into the subarachnoid space, vasculitis, brain edema and secondary ischemia; (2) stimulation of resident microglia within the CNS by bacterial compounds; and (3) possible direct toxicity of bacterial compounds on neurons . Neuronal injury is mediated by the release of reactive oxygen intermediates, proteases, cytokines and excitatory amino acids, and is executed by the activation of transcription factors, caspases and other proteases . In experimental meningitis, dexamethasone as an adjunct to antibiotic treatment leads to an aggravation of neuronal damage in the hippocampal formation, suggesting that corticosteroids might not be the ideal adjunctive therapy . Several approaches that interfere selectively with the mechanisms of neuronal injury are effective in animal models, including the use of nonbacteriolytic protein synthesis-inhibiting antibiotics, antioxidants and inhibitors of transcription factors, matrix metalloproteinases, and caspases.

Rozhl Chir, 2001 Nov, 80(11), 602 - 4
{Actinomycosis of the small intestine--an unusual cause of acute abdomen}; Belak J et al.; Actinomycosis is subacute or chronic disease manifested by a defined granulomatous inflammation with the development of infiltrates, abscesses and fistulae . A 35-year-old female patient was admitted and operated at the Second Surgical Clinic because of symptoms of diffuse peritonitis . Laparotomy revealed a duplicit tumour of the small intestine, an abscess of the abdominal wall in the left mesogastrium and pyoovarium bilaterale . 70 cm of the small intestine were resected, incision of the abscess and bilateral adnexotomy were performed . Histological examination revealed a suppurative, partly fibroproductive inflammation with an actinomycotic etiopathology . After antibiotic treatment the patient was discharged home, the gynaecologist removed an intrauterine device . Three months after the first operation the patient in a serious septic condition was readmitted to the clinic with signs of diffuse peritonitis . A double perforation of the small intestine was found and an end-to-end anastomosis was made after resection of the small intestine . The postoperative course was complicated by respiratory failure and failure of the circulation associated with septic shock and subsequent death . In the conclusion the authors emphasize the problem of preoperative diagnosis of the abdominal form of actinomycosis, its possible development in relation to intrauterine contraceptive devices and its clinical manifestation as acute abdomen.

J Neurobiol, 2002 Feb 5, 50(2), 81 - 92
Survival of bundleless hair cells and subsequent bundle replacement in the bullfrog's saccule; Gale JE et al.; Our senses of hearing and balance depend upon hair cells, the sensory receptors of the inner ear . Millions of people suffer from hearing and balance deficits caused by damage to hair cells as a result of exposure to noise, aminoglycoside antibiotics, and antitumor drugs . In some species such damage can be reversed through the production of new cells . This proliferative response is limited in mammals but it has been hypothesized that damaged hair cells might survive and undergo intracellular repair . We examined the fate of bullfrog saccular hair cells after exposure to a low dose of the aminoglycoside antibiotic gentamicin to determine whether hair cells could survive such treatment and subsequently be repaired . In organ cultures of the bullfrog saccule a combination of time-lapse video microscopy, two-photon microscopy, electron microscopy, and immunocytochemistry showed that hair cells can lose their hair bundle and survive as bundleless cells for at least 1 week . Time-lapse and electron microscopy revealed stages in the separation of the bundle from the cell body . Scanning electron microscopy (SEM) of cultures fixed 2, 4, and 7 days after antibiotic treatment showed that numerous new hair bundles were produced between 4 and 7 days of culture . Further examination revealed hair cells with small repaired hair bundles alongside damaged remnants of larger surviving bundles . The results indicate that sensory hair cells can undergo intracellular self-repair in the absence of mitosis, offering new possibilities for functional hair cell recovery and an explanation for non-proliferative recovery .

J Vet Med Sci, 2001 Dec, 63(12), 1351 - 4
Organic acid profiles in feces of pigs with pathogenic or non-pathogenic diarrhea; Tsukahara T et al.; A chemical characteristic of the feces of diarrheal piglets permits differentiation among piglets receiving antibiotic treatment and those with colibacillosis or dyspepsia . A high concentration of lactic or succinic acid was observed in the diarrheic feces of piglets receiving antibiotic treatments and those with dyspepsia; however, no lactic or succinic acids were detected in piglets with colibacillosis . There was, however, little difference in the total concentration of organic acids among the three types of diarrheal illnesses . A quantitative analysis of lactic and succinic acids in diarrheic feces might provide a means for rapidly differentiating between colibacillosis and non-pathogenic diarrheas in piglets.

Rozhl Chir, 2001 Oct, 80(10), 529 - 30
{Complications in treatment of a patient with total aganglionosis of the large intestine}; Kalavsky M; The author presents a patient with an congenital malformation, megacolon congenitum, with total agangliosis of the large bowel . Total colectomy was performed preserving part of the rectum with subsequent Duhamel's operation . After four years, at the age of 5.5 years the postoperative course was complicated by an inflammation of the rectum with the subsequent development of multiple fistulae in the perianal, perineal, gluteal and labial area . The condition had a rapid septic course . The patient was subjected to repeated ileostomy . Under general antibiotic treatment and Sulfasalazine the patient's condition improved.

Gastroenterology, 2002 Jan, 122(1), 119 - 33
Genetic or chemical hypochlorhydria is associated with inflammation that modulates parietal and G-cell populations in mice; Zavros Y et al.; BACKGROUND & AIMS: Reduced gastric acid predisposes the stomach to colonization by bacteria and inflammation . Therefore, we investigated how the chronic gastritis in mice made hypochlorhydric by either gastrin deficiency or omeprazole treatment modulates epithelial cell function . METHODS: The gastric pathology of 16-week-old wild-type gastrin-expressing (G+/+) and gastrin-deficient (G-/-) mice maintained in conventional housing was compared . G-/- mice were then treated with antibiotics for 20 days . In a separate experiment, G+/+ mice were treated with omeprazole for 2 months or treated with omeprazole and antibiotics . RESULTS: Compared with the G+/+ animals, the hypochlorhydric G-/- mice showed significant inflammation that resolved after 20 days of antibiotic treatment and correlated with a decrease in bacterial overgrowth . Elevated G- and parietal-cell numbers in the G-/- mice, quantified by flow cytometry, normalized after antibiotic treatment . G+/+ mice treated with omeprazole had increased bacteria and mucosal lymphocytes that resolved after antibiotic therapy . Quantitation of the gastric cells in these omeprazole-treated mice revealed a significant increase in G- and parietal-cell numbers . On resolution of the gastritis, a decrease in parietal and gastrin-expressing (G) cells was observed despite sustained hypochlorhydria in the presence of omeprazole . CONCLUSIONS: Genetic or chemical hypochlorhydria predisposes the stomach to bacterial overgrowth resulting in inflammation . The specific changes in parietal and G cells correlate with the presence of inflammation and not directly with gastric acid . Thus, the normal stomach responds to inflammation by increasing the number and function of cell types that are able to maximize gastric acid output.

Respir Med, 2001 Dec, 95(12), 1003 - 5
Exhaled carbon monoxide in patients with lower respiratory tract infection; Biernacki WA et al.; The concentration of carbon monoxide (CO) in exhaled air is increased in patients with asthma, bronchiectasis and upper respiratory tract viral infections . However there is no information about the level of CO in patients with lower respiratory tract infection . We studied a group of 35 patients (22 males) aged 45 +/- 3 (SEM) years with cough productive of purulent phlegm and pyrexia in a general practice setting . All were non-smokers or ex-smokers and none had a previous history of respiratory problems or diabetes . We measured CO level in exhaled air before and after a course of antibiotics . Therapy was deemed successful when patient no longer complained of cough productive of purulent phlegm . Twenty-eight of 35 patients had elevated CO level at their initial visit . Twenty-two out of 35 patients reported clinical improvement after antibiotic treatment and this was associated with a fall in exhaled CO level from 5.2 +/- 0.5 ppm to 2.3 +/- 0.3 ppm (P < 0.0001) . We suggest that simple CO measurements in exhaled air can detect the inflammatory process within the airways caused by infection and that a repeat measurement can be used to assess the nature of inflammation.

Bull Soc Pathol Exot, 2000 Jan, 93(5), 325 - 7
{Coxiella burnetii pneumopathy on return from French Guiana}; Baret M et al.; Q fever is a worldwide zoonosis but is not often a common cause of fever among travellers returning from the tropics . We report a case of acute Q fever, revealed by a pneumonia and acquired by a traveller in French Guyana . The chest radiography showed alveolar opacities and pleural effusion . Biological abnormalities were elevated liver enzyme levels and thrombocytopenia . The patient improved or the third day of antibiotic treatment . She mentioned that 3 other people she lived with during her trip had been diagnosed with Q fever . A common source outbreak was then suspected . They all stayed in the same farm in French Guyana . Animal exposure occurred there, in particular with a goat and a dog (both were parturient) . The disease was probably transmitted by airborne dust to our patient, as no other vectors of transmission were found . Since the clinical presentation of Q fever is not specific, in order for the physician to diagnose it, he must have an awareness of the disease . Our case emphasised that looking for risk factors of Coxiella burnetii exposures is particularly important . Amongst them, the most important seems to be contact with farm animals . The clinician should thus try to trace such a possible contact when treating a case of traveler's Q fever.

Appl Environ Microbiol, 2002 Jan, 68(1), 11 - 9
Effect of cold starvation, acid stress, and nutrients on metabolic activity of Helicobacter pylori; Nilsson HO et al.; Helicobacter pylori can transform, in vivo as well as in vitro, from dividing spiral-shaped forms into nonculturable coccoids, with intermediate forms called U forms . The importance of nonculturable coccoid forms of H . pylori in disease transmission and antibiotic treatment failures is unclear . Metabolic activities of actively growing as well as nonculturable H . pylori were investigated by comparing the concentrations of cellular ATP and total RNA, gene expression, presence of cytoplasmic polyphosphate granules and iron inclusions, and cellular morphology during extended broth culture and nutritional cold starvation . In addition, the effect of exposing broth-cultured or cold-starved cells to a nutrient-rich or acidic environment on the metabolic activities was investigated . ATP was detectable up to 14 days and for at least 25 days after transformation from the spiral form to the coccoid form or U form in broth-cultured and cold-starved cells, respectively . mRNAs of VacA, a 26-kDa protein, and urease A were detected by using reverse transcription-PCR in cells cultured for 2 months in broth or cold starved for at least 28 months . The ATP concentration was not affected during exposure to fresh or acidified broth, while 4- to 12-h exposures of nonculturable cells to lysed human erythrocytes increased cellular ATP 12- to 150-fold . Incubation of nonculturable cold-starved cells with an erythrocyte lysate increased total RNA expression and ureA mRNA transcription as measured by quantitative real-time reverse transcription-PCR . Furthermore, the number of structurally intact starved coccoids containing polyphosphate granules increased almost fourfold (P = 0.0022) under the same conditions . In conclusion, a specific environmental stimulus can induce ATP, polyphosphate, and RNA metabolism in nonculturable H . pylori, indicating viability of such morphological forms.

Presse Med, 2001 Dec 1, 30(36), 1770 - 6
{Epidemiology and management of suspected pneumonia in nursing home residents}; Veyssier P et al.; OBJECTIVE: We conducted a descriptive epidemiology study to examine the conditions of management of infectious lung disease in institutionalized elderly populations (population profile, diagnostic and therapeutic modalities) and to analyze the general and mental consequences in terms of independence (impact of the infectious event on the subject's life style) . PATIENTS AND METHODS: A pragmatic survey was conducted by a multicentric observatory composed of 573 general practitioners, practicing in nursing homes . The series included 1790 patients aged over 70 years and residing in nursing homes who developed infectious lung disease over a 10-month period . The MMSE score was used to assess mental status and the Barthel index to assess functional handicap . Each patient was evaluated at the time of the final diagnosis (prescription of an antibiotic or decision for hospitalization) and at most 3 days after the end of this treatment or at discharge from hospital . RESULTS: The elderly population (84 +/- 7 years) was predominantly composed of women . The patients were treated for an acute respiratory infection considered in 30% of the cases to be acute lobar pneumonia . Subgroups of patients were identified for analysis: death (3.7%), x-ray confirmation of the diagnosis (11.5%), hospitalized patients (10.2%) . In addition to major deterioration of the general health status, a consequence of the infection more than of the severity of the respiratory symptoms, the development of an acute episode coincided with reduced intellectual functions and onset of a state of confusion . In 70% of the cases, this resulted in a loss of independence of variable importance--simple difficulty for moving around to major functional handicap . The infectious episode was cured or improved (persistence of minor signs not requiring specific treatment) in 94.3% of the cases with appropriate antibiotics: single-drug regimen in 93.7% give per os (75%) or intravenously (25%) using aminopenicillin (with or without a beta lactamase inhibitor) in 80% of the cases . Antibiotic treatment was associated with physical therapy in more than half the cases, and with general conticosteroids in 40% . The treatment scheme was modified in 9.4% of the cases (change of antibiotic in 6%) . CONCLUSION: This survey confirms the high risk related to general conditions in elderly institutionalized patients who develop respiratory infection . More than the infection itself, the rapid degradation of the general health status, or decompensation of comorbid states can create life-threatening situations or favor the development of irreversible handicaps.

Chang Gung Med J, 2001 Oct, 24(10), 615 - 20
Possible cofactor in cervical carcinogenesis: proliferation index of the transformation zone in cervicitis; Yang YC et al.; BACKGROUND: Most cervical cancers arise from the transformation zone . Human papillomavirus (HPV) has been identified as playing a central role in cervical carcinogenesis . However, the lengthy period from initial HPV infection through the precancerous stage to cancer lesions implicates that the cofactors involved in the process might be random events . Our study was designed to study the relationship between the cell mitotic index and tissue inflammation of the uterine cervix . The results may help to explain the role of chronic inflammation as a possible cofactor of cervical carcinogenesis . METHODS: Using Ki-67 immunostaining, the proliferation index (PI) was determined in 30 cervices removed in hysterectomies for non-cervical diseases . The chronic cervical inflammation was graded according to quantification of inflammatory cells in adjacent stromal tissue . The relationships of these two parameters within the exocervix, the transformation zone (T-zone) and the endocervix were analyzed and their differences were compared . RESULT: A significant correlation between the microscopic inflammation scale and the PI was found in the T-zone of the cervix (p = 0.034) . The PI of the T-zone, exocervix and endocervix were significantly different (p < 0.001) with scores of 66.1 (SD 26.3), 41.6 (SD 23.3) and 7.1 (SD 5.0), respectively . CONCLUSION: The results, based on modern cellular evidence, explain, at least partially the observation that cervical cancer occurs predominantly in the T-zone and suggest that implementation of antibiotic treatment in selected human papillomavirus-infected patients might decrease the development of cervical cancer.

Rev Prat, 1998 Apr 15, 48(8), 867 - 70
{Recurrent and long-lasting otitis media in children}; Coiffier T et al.; Recurrent otitis media is especially a social and economic problem . Treatment of risk factors generally reduces the frequency of relapses, and allows to await spontaneous improvement with age and to avoid a course toward progressive chronic otitis media . Prolonged otitis media is gradually replacing classic acute mastoiditis . Its increased incidence is correlated with the selection of increasingly resistant bacteria with the influence of antibiotic use . Treatment requires bacterial sampling and often hospitalisation for parenteral antibiotic treatment.

Rev Prat, 1998 Apr 15, 48(8), 855 - 8
{Treatment of acute otitis media in children}; Francois M; Acute otitis media in children have to be treated by analgesics, antipyretics and antibiotics . The choice of the antibiotic depends on the child's age, associated clinical symptoms such as conjonctivitis, and any recent history of antibiotic treatment . Children over 2 are treated by amoxicillin or CG1, children with conjunctivitis are treated by amoxicillin + clavulanate acid, infants attending day care centers and with recent history of antibiotic treatment have to be treated by cefuroxim-axetil, cefpodoximproxetil or high dosages of amoxicillin . In case of unsatisfactory course of the disease, the infecting organism has to be identified by tympanocentesis.

Clin Invest Med, 2001 Dec, 24(6), 304 - 10
Adherence to antibiotic guidelines for pneumonia in chronic-care facilities in Ontario; Loeb M et al.; OBJECTIVES: To evaluate adherence to antibiotic recommendations for the treatment of pneumonia in patients who receive long-term care and to assess outcomes associated with these recommendations . DESIGN: A prospective cohort study . SETTING: Twenty-two facilities that provide long-term care in southern Ontario . PARTICIPANTS: Older adults treated with antibiotics for a presumptive diagnosis of pneumonia and those with radiologically confirmed pneumonia METHODS: Over a 12-month period, older patients who were treated with antibiotics for presumptive pneumonia were prospectively identified . A random sample of these antibiotic courses (646 courses in 638 patients) was reviewed using a standardized data collection form, and demographic and clinical data were collected . Antibiotic courses were classified according to Canadian and American Thoracic Society antibiotic recommendations for pneumonia . In patients with radiologically confirmed pneumonia, the effect of adherence to these recommendations on mortality and persistence of symptoms was assessed . RESULTS: Only 27.6% (178 of 646) of antibiotic prescriptions evaluated met antibiotic recommendations for nursing-home-acquired pneumonia, and the proportion meeting these varied greatly by facility, ranging from 0% to 53% (median 31%) . For patients with radiologically confirmed pneumonia, age (adjusted odds ratio {OR} 1.6, 95% confidence interval {CI} 1.0-2.4, per increase in 10 yr, p = 0.02), sex (adjusted OR 3.0, 95% CI 1.1-8.0, p = 0.03), and adherence to recommended antibiotics (OR 3.0, 95% CI 1.3-7.2, p = 0.01) were associated with death . Adherence to the recommended antibiotics was also associated with adverse reactions, which occurred in 10% of prescriptions meeting the recommendations (OR 2.4, 95% CI 1.3-4.6, p = 0.01) . CONCLUSIONS: Adherence to recommended guidelines for antibiotic treatment was low and highly variable among study facilities . Use of recommended antibiotic regimens was associated with increased adverse events and worse outcomes in patients with radiologically confirmed pneumonia.

Nurse Pract, 2001 Nov, 26(11), 14 - 6, 19-23; quiz 24-5
Community-acquired pneumonia in adults; Boldt MD et al.; The incidence and mortality rates of community-acquired pneumonia (CAP) continue to rise as patients age . The clinical presentation of CAP is variable; therefore, diagnosis can be challenging . Clinicians must rely on a careful history and physical examination when choosing empirical antibiotic treatment . Using current guidelines, this article discusses the pathogenesis, clinical presentation, differential diagnosis, prognosis, and treatment of adults with CAP in the primary care setting.

Eur J Clin Microbiol Infect Dis, 2001 Oct, 20(10), 732 - 3
Cat scratch disease due to Bartonella henselae infection mimicking parotid malignancy; Kempf VA et al.; An unusual Bartonella henselae infection presenting clinically as a putative parotid cancer was diagnosed based on serological tests, histomorphology and amplification of a 16S-rDNA sequence of Bartonella henselae . The patient improved greatly upon antibiotic treatment and did not require surgery . Although uncommon, infection with Bartonella spp., particularly Bartonella henselae, should be included in the differential diagnosis of parotid tumors.

Korean J Radiol, 2001 Apr-Jun, 2(2), 117 - 20
Granulosa cell tumor of scrotal tunics: a case report; Ji EK et al.; We report a case of adult granulosa cell tumor arising in the scrotal tunics . The patient was a 34-year-old man who presented with right scrotal swelling, first noticed four months previously . Under the initial clinical impression of epididymoorchitis, antibiotic treatment was instituted but there was no response . The paratesticular nodules revealed by ultrasound and magnetic resonance imaging mimicked intratesticular lesion, and radical orchiectomy was performed . Although several cases of adult testicular granulosa cell tumor, have been reported, the occurrence of this entity in the paratesticular area has not, as far as we are aware, been previously described.

Am J Physiol Gastrointest Liver Physiol, 2002 Jan, 282(1), G175 - 83
Hypergastrinemia in response to gastric inflammation suppresses somatostatin; Zavros Y et al.; Hypergastrinemia and a reduction in tissue somatostatin occur in Helicobacter pylori-infected patients . We investigated whether the D cell may be a direct target of gastric inflammation and hypergastrinemia . D cells were quantified by morphometry and flow cytometry in 16-wk-old wild-type (G+/+) and gastrin-deficient (G-/-) mice . Hypochlorhydric G-/- mice were treated with either antibiotics for 20 days or infused with gastrin (G-17) for 14 days . G+/+ mice were made hypochlorhydric by treating them with omeprazole for 2 mo . G-/- mice showed significant inflammation compared with the G+/+ mice, which resolved after 20 days of antibiotic treatment . D cell numbers were not significantly different between G-/- and G+/+ mice . After G-17 was infused, fundic and antral D cell numbers decreased in the G-/- mice . G+/+ animals made hypergastrinemic with omeprazole exhibited decreased D cell numbers . When omeprazole-treated mice were treated with antibiotics alone, elevated plasma gastrin levels returned to baseline and D cell numbers returned to resting levels despite persistent hypochlorhydria . Hypergastrinemia, induced by inflammation, results in decreased D cell numbers . Thus the stomach responds to the presence of inflammation by reducing somatostatin levels, thereby releasing the inhibition on the G and parietal cells to maximize gastric acid output.

J Bone Joint Surg Am, 2001 Dec, 83-A(12), 1810 - 3
Differentiation between bone infarction and acute osteomyelitis in children with sickle-cell disease with use of sequential radionuclide bone-marrow and bone scans; Skaggs DL et al.; BACKGROUND: The differentiation of bone infarction from acute osteomyelitis in patients with sickle-cell disease is challenging, as the clinical presentations of the two conditions are similar and imaging and laboratory studies are of limited value . METHODS: A combination of radionuclide bone-marrow and bone scans was performed sequentially within a twenty-four-hour period (with one exception) to aid in the differentiation between bone infarction and osteomyelitis in seventy-nine consecutive episodes of acute bone pain in children with sickle-cell disease . RESULTS: Seventy cases of bone infarction were diagnosed on the basis of decreased uptake on the bone-marrow scan and abnormal uptake on the bone scan at the site of pain . Antibiotic administration was discontinued in sixty-six of the seventy cases after the imaging results were obtained, and the bone pain resolved . In four of the seventy-nine cases, there was normal uptake on the bone-marrow scan and abnormal uptake on the bone scan at the site of pain, findings that were suggestive of acute osteomyelitis . In three of these cases, osteomyelitis was proven by culture, and the symptoms in all four resolved with antibiotic treatment . In five of the seventy-nine cases, the bone-marrow and bone scans were normal and thought to indicate neither osteomyelitis nor bone infarction; in all of these cases, the symptoms resolved without the use of antibiotics . CONCLUSIONS: These findings suggest that osteomyelitis can be differentiated from bone infarction in children with sickle-cell anemia and acute bone pain by a combination of sequential bone-marrow and bone scintigraphy.

J Infect Dis, 2001 Dec 15, 184(12), 1581 - 8 Epub 2001 Dec 03.
Chlamydial genovar distribution after community wide antibiotic treatment; Bain DL et al.; Major outer membrane protein sequences, determined from Chlamydia-positive eye swab samples collected in 2 Egyptian villages, were used to analyze the epidemiology of trachoma in an endemic setting . Samples were collected during the 1999 Azithromycin in Control of Trachoma trial, in which residents of villages were mass treated with either oral azithromycin or topical tetracycline and were followed up for nearly 2 years . Three genovar families (A, Ba, and C) and 12 genovars were detected, with 2 genovars (A1 and Ba1) comprising almost 75% of the samples . The presence of >1 genovar within households was common, with > or =24% of households having >1 genovar . Evidence consistent with reinfection and persistence as mechanisms of communitywide continued presence of trachoma was provided by data for individuals infected with rare genovars.

Minerva Anestesiol, 2001 Oct, 67(10), 731 - 6
{Descending necrotizing mediastinitis . Clinical experience and review of the literature}; Pellis T et al.; The occurrence of a Descending Necrotizing Mediastinistis (DNM) usually is a consequence of oropharyngeal infections, which ultimately invade the mediastinum via the cervical fasciae . The clinical course is rapid and often fatal, and is associated with severe systemic symptoms, including fever and hypotension . In these cases, an aggressive surgical approach associated with an appropriate antibiotic treatment is mandatory . Personal experience in the treatment of DNM is presented and a review of the current literature is made; moreover an operative algorhythm is presented.

Clin Microbiol Infect, 2001 Nov, 7(11), 645 - 7
Fungemia due to Scedosporium prolificans: a description of two cases with fatal outcome; Simarro E et al.; Two cases, probably related, of fungemia due to Scedosporium prolificans are described in two patients with acute leukemia . Both were admitted to the hematological ward in nearby rooms, during building work in the hospital . After a previous bacterial sepsis in the neutropenic phase, which improved with antibiotic treatment, the respiratory status in both patients deteriorated presenting acute dypsnea, with a lung infiltrate in one of them . A few hours later both patients died . Blood cultures were positive for S . prolificans . These two new cases of S . prolificans infection stress the importance of awareness of this emerging pathogen in patients who suffer a hematologic malignancy during the neutropenic phase, especially if building work is taking place in the hospital.

ANZ J Surg, 2001 Nov, 71(11), 662 - 4
Cost of surgical site infections following coronary artery bypass surgery; Jenney AW et al.; BACKGROUND: Little information is available on the financial impact of surgical site infections (SSI) after major surgery . In order to calculate the cost of SSI following coronary artery bypass graft surgery (CABGs), a 2-year retrospective case-control study was undertaken at Alfred Hospital, a university-affiliated tertiary referral centre . METHODS: One hundred and eight patients with SSI (cases) after CABGs and 108 patients without SSI (controls) were matched for gender, age, risk index (Centers of Disease Control and Prevention, National Nosocomial Infection Surveillance (NNIS) System) and number of principal comorbidities . The patient's postoperative length of stay (LOS), in both the intensive care unit (ICU) and the non-ICU (general) ward, was obtained from the medical records and the cost of a day in each was provided by the hospital's finance department . The cost of antibiotics prescribed for SSI was provided by the hospital's pharmacy department . RESULTS: Postoperatively the cases were in ICU for a total of 313 days whereas the controls spent 165 days in ICU, a mean of 2.89 versus 1.53 days, respectively (P = 0.035) . In general wards, cases were inpatients for a total of 1651 days and controls for 589 days . This is a mean of 10.8 days for cases and 4.7 days for controls (P = 0.0001) . The extra LOS for 108 cases (compared to the controls) was costed at $1 299 082, a mean cost of $12 028 per patient . The total cost of antibiotics prescribed for these SSI was $42 270 (a cost per case of $391) . The total excess cost related to increased LOS and antibiotic treatment was $12 419 per patient . In the subgroup analysis for deep sternal site infections the mean excess cost was $31 597 per patient . CONCLUSIONS: Postoperative SSI result in significant patient morbidity and consume considerable resources . In the present study, patients with SSI following CABGs had significant prolongation of hospitalization (both in ICU and general wards) . The present study illustrates the potential cost savings of introducing interventions to reduce SSI rates . This is the first time such a study has been undertaken in Australia.

Arch Bronconeumol, 2001 Dec, 37(11), 511 - 2
{Pulmonary nocardiosis as a cause of radiographic imaging of multiple pulmonary nodules}; Pifarre R et al.; Lung nocardiosis is a rare disease affecting patients with lymphoreticular neoplasm, immunodeficiency or chronic obstructive pulmonary disease; it can also affect patients who have received transplants . We report a case of lung nocardiosis in which radiographic presentation was acute, with a pattern of multiple bilateral pulmonary nodules ("cannonballs"), requiring us to rule out metastatic disease to arrive at a diagnosis . The patient responded slowly to antibiotic treatment until full resolution.

Ophthalmology, 2001 Dec, 108(12), 2225 - 31
Ocular Whipple's disease: earlier definitive diagnosis; Chan RY et al.; PURPOSE: Whipple's disease is a rare, chronic, and multiorgan bacterial disease that predominantly involves the gut and its lymphatic drainage in middle-aged Caucasian men but may involve the eye . It is often difficult to diagnose and treat . We report results of one more polymerase chain reaction (PCR) analysis-diagnosed ocular Whipple's disease (OWD) case and the care of three new patients with ocular inflammation caused by OWD . DESIGN: Retrospective noncomparative case series . PARTICIPANTS: Three patients . METHODS: Diagnostic PCR was performed on a vitreous sample, medical records of three patients with OWD were reviewed, and a literature review (1907 to present) located 74 OWD cases . Analysis of published OWD cases to seek out factors that contribute to earlier, definitive diagnosis and treatment of OWD is made . MAIN OUTCOME MEASURES: Response of ocular inflammation and vision to treatment . RESULTS: One of 3 new and 4 of 74 published OWD cases reviewed were diagnosed with PCR on vitreous samples and subsequently successfully treated with antibiotics without devastating central nervous system (CNS) sequelae . CONCLUSION: Diagnostic PCR on vitreous samples and recognition of key presenting symptoms in patients with OWD allows earlier definitive diagnosis, when the disease may be more amenable to antibiotic treatment, compared with "late" CNS Whipple's disease in the cases reviewed.

Pediatrics, 2001 Dec, 108(6), 1367 - 70
Management of tick bites and early Lyme disease: a survey of Connecticut physicians; Murray T et al.; Practice guidelines have been published for the treatment of Lyme disease (LD) . These guidelines have been challenged as inadequate . Two common LD management problems are antibiotic prophylaxis of deer tick bites (deer ticks may carry Borrelia burgdorferi, the spirochete that causes LD) and antibiotic treatment of erythema migrans, the pathognomonic rash of LD . A 1-page questionnaire was sent to a 13% (573/4300) sample of Connecticut physicians to define how they treat deer tick bites and erythema migrans . Questionnaires were returned by 320 (56%) of 573 physicians . Questionnaires were analyzed for the 267 physicians who saw patients with LD . Seventy (26%) of the 267 surveyed physicians prescribed antibiotic prophylaxis for patients with tick bites . B burgdorferi serology was ordered by 31% of physicians for patients with tick bites . Most surveyed physicians treated erythema migrans with doxycycline or amoxicillin for a mean of 21 days . Serology was ordered by 49% of physicians for patients with erythema migrans . Most physicians did not use prophylaxis for patients with deer tick bites . In addition, most of the physicians surveyed followed established guidelines for treating patients with erythema migrans . However, many of the physicians surveyed do serologic testing for patients with tick bites and/or erythema migrans . Serologic testing for these patients is usually not necessary.

Atherosclerosis, 2001 Dec, 159(2), 521 - 5
Prevalence of Chlamydia pneumoniae in peripheral blood mononuclear cells in Italian patients with acute ischaemic heart disease; Sessa R et al.; Chlamydia pneumoniae infection generally starts in the respiratory tract and probably disseminates systemically in the blood stream within alveolar macrophages . We investigated the prevalence of C . pneumoniae DNA in peripheral blood mononuclear cells (PBMC) in patients with acute ischaemic heart disease . Samples of blood were obtained from 93 consecutive patients with acute ischaemic heart disease and from 42 healthy subjects, for detection of C . pneumoniae DNA in PBMC by polymerase chain reaction (PCR) and for serology . C . pneumoniae DNA in PBMC was detected in 25.8% (24/93) of the patients with acute ischaemic heart disease and in 4.8% (2/42) of the healthy subjects (P=0.008) . C . pneumoniae IgG was found in 76.3% of patients and in 45.2% of healthy subjects (P=0.0008) while C . pneumoniae IgA was found in 59.1% and in 33.3%, respectively (P=0.01) . No correlation was found between anti-C . pneumoniae antibody titers and positive PCR results . The detection of C . pneumoniae DNA in PBMC may aid in selecting patients who may benefit from antibiotic treatment; however, to support this contention, longitudinal studies on patients treated with antibiotics would also be necessary.

Clin Ther, 2001 Oct, 23(10), 1747 - 72
Selection of clinical, patient-reported, and economic end points in acute exacerbation of chronic bronchitis; Perfetto EM et al.; BACKGROUND: Acute exacerbation of chronic bronchitis (AECB) places tremendous burden on patients, providers, employers, and health care systems . OBJECTIVE: The purpose of this paper is to (1) review the clinical, patient-reported, and economic measures used to evaluate disease burden and treatment effectiveness in AECB in clinical trials and (2) propose a guide for selecting study end points in AECB that will help capture all the relevant disease outcomes . METHODS: Two literature searches of the PubMed database were conducted to identify studies of clinical trials in bronchitis and evaluate the clinical, patient-reported, and economic end points used in these studies . RESULTS: Previous studies have focused primarily on clinician-assessed outcomes, which do not capture the full impact of AECB on patients' lives . Reporting mechanisms for most end points have been inconsistent, limiting the ability to compare information or interpret differences . Previous studies have given limited attention to patient-reported outcomes and the economic implications of AECB . Patient-reported outcomes such as speed of symptom relief and work productivity are important parameters for assessing treatment effectiveness and provide practical information for treatment evaluation . CONCLUSIONS: Additional research is needed to develop, examine, and validate patient-reported outcomes and the indirect costs of AECB . Measuring the relevant clinical, economic, and patient-reported outcomes in AECB patients using standardized methods may lead to a clearer understanding of the disease burden and the role, effectiveness, and cost-effectiveness of antibiotic treatment.

Postgrad Med J, 2001 Dec, 77(914), 778 - 82
Determinants for the course of acute sinusitis in adult general practice patients; Stalman WA et al.; BACKGROUND: Although the prognosis of acute sinusitis is important, little is known about it and the factors predicting its course in a general practice population . OBJECTIVE: To determine the course of acute sinusitis and factors predicting it in adults in general practice . METHODS: The prognostic value of demographic and clinical factors and the patient's emotional state, for example anxious or depressed, were determined prospectively by means of multivariate analysis . MAIN OUTCOME MEASUREMENTS: Resolution of facial pain, resumption of daily activities, and the patient's reported improvement . Factors with a significant predictive value were used to classify the patients into three different groups: quick, moderate, and slow recovery . RESULTS: The median time from enrollment to recovery was six (range percentile 25-75: 4-10) days in a population of 177 patients . Factors predictive of a prolonged clinical course were: female sex (hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.42 to 0.83), history longer than 14 days before inclusion (HR 0.62; 95% CI 0.41 to 0.94), headache, cold, or cough as a reason for the encounter (HR 0.65; 95% CI 0.44 to 0.96), and absence of cervical adenopathy (HR 0.71; 95% CI 0.51 to 0.96) . Antibiotic treatment did not influence the course of disease . The median time to recovery was three days for patients with a quick, five days for those with a moderate, and seven days for those with a slow recovery . CONCLUSION: In general practice acute sinusitis is mostly a self limiting disease . A limited number of characteristics are predictive of a (slightly) prolonged clinical course of acute sinusitis in general practice.

Blood, 2001 Dec 1, 98(12), 3309 - 14
Increased granulopoiesis through interleukin-17 and granulocyte colony-stimulating factor in leukocyte adhesion molecule-deficient mice; Forlow SB et al.; Many mutant mice deficient in leukocyte adhesion molecules display altered hematopoiesis and neutrophilia . This study investigated whether peripheral blood neutrophil concentrations in these mice are elevated as a result of accumulation of neutrophils in the circulation or altered hematopoiesis mediated by a disrupted regulatory feedback loop . Chimeric mice were generated by transplanting various ratios of CD18(+/+) and CD18(-/-) unfractionated bone marrow cells into lethally irradiated wild-type mice, resulting in approximately 0%, 10%, 50%, 90%, or 100% CD18 null neutrophils in the blood . The presence of only 10% CD18(+/+) neutrophils was sufficient to prevent the severe neutrophilia seen in mice reconstituted with CD18(-/-) bone marrow cells . These data show that the neutrophilia in CD18(-/-) mice is not caused by enhanced neutrophil survival or the inability of neutrophils to leave the vascular compartment . In CD18(-/-), CD18(-/-)E(-/-), CD18(-/-)P(-/-), EP(-/-), and EPI(-/-) mice, levels of granulocyte colony-stimulating factor (G-CSF) and interleukin-17 (IL-17) were elevated in proportion to the neutrophilia seen in these mice, regardless of the underlying mutation . Antibiotic treatment or the propensity to develop skin lesions did not correlate with neutrophil counts . Blocking IL-17 or G-CSF function in vivo significantly reduced neutrophil counts in severely neutrophilic mice by approximately 50% (P <.05) or 70% (P <.01), respectively . These data show that peripheral blood neutrophil numbers are regulated by a feedback loop involving G-CSF and IL-17 and that this feedback loop is disrupted when neutrophils cannot migrate into peripheral tissues.

Acta Otolaryngol, 2001 Oct, 121(7), 823 - 30
Serum and cerebrospinal fluid pathology in patients with sudden sensorineural hearing loss; Finizia C et al.; The serum and cerebrospinal fluid (CSF) pathology of patients with sudden sensorineural hearing loss (SHL), both seropositive and seronegative to Borrelia burgdorferi (Bb), was prospectively studied . Nineteen consecutive patients were included and trends between the degree of hearing recovery and serum/CSF pathology and given therapy were examined . The pilot study showed a high prevalence (68%) of pathology in serum and CSF in patients with SHL . In 54% of the patients, elevated levels of CSF proteins and/or pathological CSF cell counts were present without positive antibodies to Bb . Positive levels of antibodies against Bb or pathological proteins in CSF were associated with better hearing recovery (means of 47.2 and 51.7%, respectively) . The audiometric configuration "high frequency sloping" hearing impairment was associated with the lowest degree of hearing recovery . Patients with SHL and positive serology to Bb who received antibiotic treatment (oral tetracycline), with or without steroids, had the best hearing recovery in this study (61.7 and 48.4%, respectively) . In conclusion, we found a high prevalence of serum and CSF pathology in a consecutive group of patients with SHL . Early appropriate antibiotic treatment may prevent the development of major late complications of Lyme disease/borreliosis . We also find it justified to perform more general serological analyses, including CSF analysis, in patients with SHL . A more liberal approach to testing and development of test protocols for SHL patients will increase our knowledge in this field.

Eur J Surg, 2001 Aug, 167(8), 622 - 4
Pentoxifylline in perforated peritonitis: results of a randomised, placebo controlled trial; Shukla VK et al.; OBJECTIVES: To evaluate the role of pentoxifylline as an adjuvant to operation and routine antibiotic treatment for perforated peritonitis . DESIGN: Randomised controlled clinical trial . SETTINGS: University hospital, India . SUBJECTS: 36 patients with clinically diagnosed and radiologically confirmed perforated peritonitis . 22 (61%) had typhoid enteric perforations, 11 (31%) had duodenal ulcer perforations while 3 (8%) had perforated gastric ulcers . INTERVENTION: Laparotomy with closure of perforation and lavage together with routine antibiotic treatment (ciprofloxacin and metronidazole), and random allocation to pentoxifylline 200 mg/day for 3 days in 500 ml of saline over 3-4 hours or saline alone (n = 18 in each group) . MAIN OUTCOME MEASURES: Hospital stay, APACHE II scores, and the condition of the wound during the postoperative period . RESULTS: The baseline characteristics of the two groups were essentially similar . However, their preoperative APACHE II scores differed significantly (mean (SD) 12 (3) in the pentoxifylline group compared with 10 (2) in the saline group; p <0.01) . The outcome was better in the pentoxifylline group in terms of significantly reduced hospital stay (median 8, range 6-17, compared with 11, 7-27, p=0.02) improved postoperative APACHE II scores (mean (SD) 8 (2) compared with 9 (2), p=0.02), and reduced incidence of wound infection (6/18 compared with 12/18, p=0.02) . CONCLUSION: The addition of pentoxifylline to our standard management protocol for patients with perforated peritonitis helped to improve their outcome significantly compared with a placebo-treated group.

Cardiovasc Drugs Ther, 2001, 15(3), 259 - 62
In vitro susceptibility and eradication of Chlamydia pneumoniae cardiovascular strains from coronary artery endothelium and smooth muscle cells; Gieffers J et al.; Recovery of viable Chlamydia pneumoniae from atheromas of coronary heart diseases patients has initiated pilot studies to eradicate C . pneumoniae from vascular tissue by antibiotic treatment . To provide data for the selection of effective antibiotics, we investigated the in vitro activity of anti-chlamydial antibiotics to eliminate vascular strains of C . pneumoniae from coronary endothelial and smooth muscle cells, celltypes that are involved in the pathogenesis of atherosclerosis . METHODS: The susceptibility of the obligate intracellular chlamydiae was studied in primary coronary endothelial cells, smooth muscle cells and immortalized epithelial cells . Minimal inhibitory concentrations (MICs) were determined for ofloxacin, levofloxacin, trovafloxacin, moxifloxacin, erythromycin, azithromycin, roxithromycin, rifapentin and rifampin . RESULTS: In vitro, rifampin was the most effective drug overall . Moxifloxacin and trovafloxacin were as effective as the macrolides of which roxithromycin was the most active one . CONCLUSIONS: Actively replicating C . pneumoniae can be eliminated in vitro from cell types, involved in the pathogenesis of atherosclerosis by various antibiotics . These data provide an experimental background for the selection of antibiotics in clinical eradication studies and will help to assess the potential success of prevention and eradication therapies.

Am J Otolaryngol, 2001 Nov-Dec, 22(6), 415 - 9
Synergistic necrotizing cellulitis as a complication of peritonsillar abscess; Goldenberg D et al.; Peritonsillar abscess, a complication of tonsillitis, is not uncommon . The usual treatment consists of needle aspiration or surgical drainage and antibiotic treatment . Tonsillectomy may be used in the management of this condition, either at the time of diagnosis or after an interval period . Severe complications of peritonsillar abscess are rare . Synergistic necrotizing cellulitis is a fulminant infection associated with spread along fascial plains, necrosis of connective tissue and muscle, and high mortality . It is usually otondogenic in origin in the cervicofacial area and occurs in debilitated or immune compromised patients . We discuss cervicofacial-necrotizing soft tissue disease and report an unusual case of extensive synergistic necrotizing cellulitis of the neck, chest, and shoulder as a result of a peritonsillar abscess.

Orv Hetil, 2001 Oct 7, 142(40), 2197 - 200
{Unusual manifestations of Bartonella infections}; Tokodi I et al.; The authors review the cases of two patients with an atypical form of cat scratch disease . The first case exhibited ileocoecal and hepatoportal lymphadenitis, and the second case the emerging symptoms of a non-specific granulomatous process in the middle third of the right forearm, which caused a differential-diagnostic problem . Establishment of a diagnosis was possible only on the basis of the disease process and the pathological, serological and histopathological pictures of the lymphatic glands after other causes of the lymphadenopathy had been excluded . Following two weeks of antibiotic treatment, the patients were free of complaints- and symptoms . Bartonella antibody tests were performed on 5 cats living in the neighbourhood of the patients with titer determinations too in 3 cases.

Leuk Lymphoma, 2001 Aug, 42(4), 639 - 47
Changes in pattern of immunoglobulin heavy chain gene rearrangement and MIB-1 staining before and after eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tissue (MALT) lymphoma; Kanda M et al.; Gastric low-grade mucosa-associated lymphoid tissue (MALT) lymphomas are strongly associated with infection by Helicobacter pylori (H . pylori) . Antibiotic treatment for H . pylori induces a sustained remission in a significant number of patients . We report here the outcome in 13 patients with gastric low-grade MALT lymphomas or suspected gastric lesions, treated for eradication of H . pylori . Patients were followed closely with sequential histological studies, polymerase chain reaction (PCR) amplification of the immunoglobulin heavy chain (IgH) gene and immunohistochemistry for MIB-1 . Antibiotic therapy resulted in eradication of H . pylori in all but one case, as assessed histologically . In 12 cases with successful eradication, complete regression was observed histologically in 9 cases (75%) and no regression in 3 (25%) . In 7 of 9 (78%) patients who had a complete remission, clonal bands of IgH gene detected on PCR before therapy disappeared after therapy . All 9 patients with complete regression showed a reduced number of MIB-1 positive cells, while 4 cases with no change or disease progression showed no change or increased number of MIB-1 positive cells . There was a strong relationship between density of MIB-1-positive cells and histological score . These results indicate that combination analysis of PCR of IgH and MIB-1 seems to represent a very good current approach for the diagnosis of gastric low-grade MALT lymphoma and to assess the effects of chemotherapy, especially in problematic cases.

Acta Paediatr, 2001 Oct, 90(10), 1199 - 201
A relatively low prevalence of Helicobacter pylori infection in a healthy paediatric population in Riga, Latvia: a cross-sectional study; Daugule I et al.; The aim of this study was to investigate the prevalence, age of acquisition and risk factors for Helicobacter pylori (H . pylori) among asymptomatic children . 13C-urea breath tests and questionnaires were obtained from 142 children and 40 parents . The prevalence of H . pylori was 19% . H . pylori positivity was higher in children with a positive parent (p=0.003) and independently inversely related to antibiotic treatment during the previous year in preschool children (p = 0.045) . CONCLUSION: The prevalence of H . pylori in children in Riga is higher than that in Western countries, but lower than that in Eastern European countries . H . pylori is present during the second year of life and is influenced by parental H . pylori status and previous treatment with antibiotics.

Schweiz Rundsch Med Prax, 2001 Oct 18, 90(42), 1810 - 8
{Complications of acute ENT infections}; Muller W; Acute infections in the head and neck belong to the most frequent human diseases and account for a high percentage of prescriptions for oral antibiotics . Because most infections only need symptomatic treatment and with the doubtful benefit of antibiotic treatment in some studies there is consense that routinely prescribed antibiotics for infections of the upper airway should be abandoned . Uncritical use of antibiotics is a likely cause for an increasing rate of drug resistant bacteria and many antibiotics have side effects . On the other hand the rate of serious complications of infections in the head and neck might increase if restrictions for the prescription of antibiotics are too strong . Only an adequate antibiotic treatment minimizes the rate of infectious complications and surgical procedures needed . In general serious complications of acute infections in the head and neck are rare but when appearing they might be life-threatening . The family doctor plays an important role in the early recognition and proper management of these infections . Symptoms, differential diagnostic considerations and treatment options of the most common infections in the head and neck are therefore presented.

Cochrane Database Syst Rev . 2001;(3):CD001143.
Antibiotics for syphilis diagnosed during pregnancy; Walker GJ; BACKGROUND: Congenital syphilis is an increasing problem in many developing countries and in the transitional economies of Eastern Europe and the former Soviet Union . In several countries this increase has been aggravated by HIV/AIDS . While the effectiveness of penicillin in the treatment of syphilis in pregnant women and the prevention of congenital syphilis was established shortly after the introduction of penicillin in the 1940s, there is uncertainty about the optimal treatment regimens . OBJECTIVES: To identify the most effective antibiotic treatment regimen (in terms of dose, length of course and mode of administration) of syphilis with and without concomitant infection with HIV for pregnant women infected with syphilis . SEARCH STRATEGY: MEDLINE 1966 to March 2000; EMBASE 1974 to March 2000, the Cochrane Controlled Trials Register (last searched March 2001), the Cochrane Pregnancy and Childbirth group trials register (last searched March 2001) and the references of traditional reviews were searched . Experts in specialist units were contacted . SELECTION CRITERIA: It was planned that any trial in which an attempt is made to allocate treatment for syphilis during pregnancy by a random or quasi-random method would be included in this review . DATA COLLECTION AND ANALYSIS: Information was extracted using a data extraction sheet and this included entry criteria, the source of controls, and whether the authors stratified by the stage of pregnancy when the diagnosis of syphilis was made . MAIN RESULTS: Twenty six studies met the criteria for detailed scrutiny . However, none of these met the pre-determined criteria for comparative groups and none included comparisons between randomly allocated groups of pregnant women . REVIEWER'S CONCLUSIONS: While there is no doubt that penicillin is effective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis, uncertainty remains about what are the optimal treatment regimens . Further studies are needed to evaluate treatment failure cases with currently recommended regimens and this should include an assessment of the role of HIV infection in cases of prenatal syphilis treatment failure . The effectiveness of various antibiotic regimens for the treatment of primary and secondary syphilis in pregnant women need to be assessed using randomised controlled trials which compare them with existing recommendations.

Eur J Gastroenterol Hepatol, 2001 Aug, 13 Suppl 2, S3 - 7
Key points from the revised Maastricht Consensus Report: the impact on general practice; Bazzoli F; The Maastricht 2 Consensus Report features evidence-based recommendations for the management of Helicobacter pylori infection . Strongly recommended indications for H . pylori eradication include duodenal and gastric ulcer, mucosa-associated lymphoid tissue lymphoma, atrophic gastritis, post gastric cancer resection, first-degree relation to gastric cancer patients, and patient's wishes . Advisable indications include functional dyspepsia, with the statement that eradication can lead to long-term improvement of symptoms in a subset of patients . Because H . pylori eradication does not cause gastro-oesophageal reflux disease (GORD) in most patients, or exacerbate existing GORD, H . pylori should be eradicated in patients requiring long-term acid suppression . Also advisable is H . pylori eradication before administration of non-steroidal anti-inflammatory drugs (NSAIDs), although this alone may be insufficient to reduce recurrent bleeding or enhance ulcer healing in patients receiving antisecretory therapy who continue to take NSAIDs . Maastricht 2 also introduced the concept of the 'treatment package' that considers first- and second-line eradication therapies together . A 'search and treat' strategy should be considered in patients with peptic ulcers; for patients with uncomplicated duodenal ulcer, administration of proton pump inhibitors can be limited to the period of antibiotic treatment.

Med Clin North Am, 2001 Nov, 85(6), 1427 - 40
Achieving a safe and early discharge for patients with community-acquired pneumonia; Rhew DC et al.; The rationale for achieving an early discharge for patients with CAP is that reduced length of stay can result in lower costs . When hospital discharge is premature, however, use of resources after discharge from the hospital may increase . This situation could increase overall cost and worsen quality of care . The objective should be to achieve a safe and early discharge . Several studies have evaluated methods for achieving this goal . Key findings from these studies are as follows: When a patient achieves clinical stability (e.g., systolic blood pressure, > or = 90 mm Hg; heart rate, < or = 100 beats/min; respiratory rate, < or = 24 breaths/min; temperature, < or = 38.3 degrees C {101 degrees F}; oxygen saturation, > or = 90%; able to eat; and stable mental status) or fulfills appropriate criteria (see Table 2), the patient may be eligible for switch from parenteral to oral antibiotics and early discharge . For many patients, this switch or discharge may occur on day 3 of hospitalization . When a patient is switched from parenteral to oral antibiotics, in many cases there does not appear to be a demonstrable clinical benefit to in-hospital observation . Elimination of in-hospital observation for patients who do not have an obvious reason for continued hospitalization potentially could reduce length of stay by 1 day . Improving efficiency of care reduces length of stay . This reduction may be accomplished by implementing clinical pathways, identifying and correcting causes of medically unnecessary hospital days, initiating early discharge planning, enlisting the services of a discharge coordinator, and organizing outpatient parenteral antibiotic treatment programs . These strategies are effective in many but not all patients, and their application should be tempered with careful clinical judgment.

Skeletal Radiol, 2001 Oct, 30(10), 565 - 9
Gout: radiographic findings mimicking infection; Rousseau I et al.; OBJECTIVE: To describe radiographic features of gout that may mimic infection . DESIGN AND PATIENTS: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis . Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy . Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout . CONCLUSION: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment . The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals.

J Thorac Imaging, 2001 Oct, 16(4), 307 - 9
Severe alveolar proteinosis following chemotherapy for acute myeloid leukemia in a lung allograft recipient; Du EZ et al.; A 64-year-old man was diagnosed with acute myeloid leukemia (AML) 5 years following single lung transplantation performed for severe pulmonary hypertension from scleroderma . Chemotherapy for treatment of AML with fludarabine, cytosine arabinoside, G-CSF (FLAG) regimen was initiated . Despite intensive antibiotic treatment for a presumptive diagnosis of bacterial pneumonia, the patient developed acute respiratory failure and died before a complete cycle of chemotherapy could be administered . At autopsy, both native and allograft lungs showed widespread alveolar proteinosis that was determined as the main cause of acute respiratory failure . Alveolar proteinosis, a potentially treatable disease, should be considered in the radiologic differential diagnosis of diffuse lung disease in this clinical setting.

Herz, 2001 Sep, 26(6), 409 - 17
{Surgical treatment of infective endocarditis: the Essen experiences}; Herold U et al.; BACKGROUND: Instead of immediate diagnosis and effective antibiotic treatment morbidity and mortality in infective endocarditis remains high . If the infection cannot be controlled or the disease progresses irreversible destruction of cardiac structures results . SURGICAL THERAPY: In this case surgical therapy should be considered immediately . The outcome of surgical repair is not depending on the implanted prosthesis, but solely on timing of the operation.

J Fr Ophtalmol, 2001 Sep, 24(7), 769 - 77
{Posterior segment intraocular foreign bodies . Initial management}; Roman S; Intraocular foreign bodies (IOFB) are a public health challenge because they are a major cause of poor vision in the young population . Initial management must be adapted to each case . The history analyzes the trauma circumstances and tries to determine the nature of the IOFB . The ocular examination must be complete . After a systemic antibiotic treatment has been prescribed, the patient is evaluated with plain radiography and a CT scan . The wound will be sutured as soon as possible . The IOFB will usually be removed later using vitrectomy . However, a pars plana magnet extraction can still be considered in some selected cases.

Schweiz Rundsch Med Prax, 2001 Oct 4, 90(40), 1721 - 4
{Stiff neck--what to consider}; Rossi M; Many conditions are associated with neck stiffness . Because of the threatening consequences, bacterial meningitis needs special consideration . The sensitivity of the physical examination is discussed: absence of fever, neck stiffness and altered mental status excludes the diagnosis of bacterial meningitis . Lumbar punction with cerebrospinal fluid examination remains the pivotal diagnostic procedure . A previous CT-scan to exclude increased intracranial pressure is indicated only in special risk situations and delayed antibiotic treatment must be avoided . Ceftriaxon is the standard empiric treatment in immunocompetent adult patients . According to the risk for pneumococcal resistance addition of vancomycin or rifampicin is indicated.

Med Clin North Am, 2001 Nov, 85(6), 1397 - 411
How should we make the admission decision in community-acquired pneumonia?
Aronsky D, Dean NC.
The spectrum of pneumonia patients ranges from only slightly compromised patients to patients who require life-sustaining measures . Admission decision support algorithms usually are not required for patients at either end of the spectrum . For patients presenting with intermediate severity of illness, decision support algorithms have shown that they can support clinicians in the admission decision and complement the clinicians' experience and clinical judgment with an objective tool . Clinical information systems may help overcome the existing obstacles to successful implementation . Successful guideline implementation in a clinical setting includes strategies that target not only the disease, but also include other forces that significantly influence the admission decision . Shared decision making and better managing of patients' expectations about treatment and prognosis need to be incorporated in the overall admission decision . The availability of improved outpatient management, such as outpatient intravenous antibiotic treatment and home health care, and a change in physicians' perspectives and patients' expectations may help to increase the proportion of outpatient management without compromising the quality of care . Decision support tools for pneumonia are available and show promising results . Further studies are needed, however, that show the successful dissemination and clinical implementation during routine patient care . Studies are needed that assess the impact of guidelines and prediction rules on patient outcomes . As the example of the PSI shows, the development, implementation, and dissemination of admission decision support systems is not a revolutionary, but a stepwise, evolutionary process that requires many years of research.

J Infect, 2001 Aug, 43(2), 135 - 9
Outcome of varicella pneumonitis in immunocompetent adults requiring treatment in a high dependency unit; Jones AM et al.; OBJECTIVES: The incidence of varicella infection is increasing in adults, where primary pneumonitis is the main complication . Little information exists concerning treatment of those patients who require admission to a high dependency unit (HDU) facility . A study was performed to examine the risk factors for developing varicella pneumonitis (VP), to document disease progression and assess prognosis for patients with VP requiring HDU admission . METHODS: A 10-year retrospective casenote review of patients admitted to the Regional Infectious Diseases Unit HDU . Varicella pneumonitis (VP) was defined as diffuse nodular shadowing on a chest X-ray (CXR) of a patient with a classical chickenpox rash . Severe pneumonitis was defined as an hypoxaemia index (pO2 in mmHG/FiO2) of less than 150 at any time during hospital stay . All patients were treated with intravenous acyclovir at a dose of 10 mg/kg . RESULTS: A total of 33 patients were admitted to the HDU with VP over the study period, 30 were included in the study . Annual admission rates remained constant . Most patients (76.7%) had at least one recognised risk factor for severe VP: smoking 18/30, pregnancy 9/30, chronic lung disease 7/30 . Twelve (40%) patients had severe VP, eight (26.7%) required assisted ventilation . The presence of greater than one risk factor (p < 0.02) was associated with progression to severe VP . There was one death: a 63-year-old man with a long history of chronic airflow limitation whose treatment had included domicillary long-term oxygen therapy . Nine (30%) patients developed secondary bacterial pneumonia; all recovered with appropriate antibiotic treatment . The period of stay in HDU for the majority of patients was short (mean 4.5 days) . CONCLUSIONS: The prognosis for severe adult VP with current available treatment is good . The only predictor on admission for severe VP is the presence of more than one recognised risk factor for developing VP .

JAMA, 2001 Oct 17, 286(15), 1849 - 56
Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis; Piccirillo JF et al.; CONTEXT: Studies suggest little benefit in relief of acute sinusitis symptoms from the use of newer and more expensive (second-line) antibiotics instead of older and less expensive (first-line) antibiotics . However, researchers have failed to include development of complications and cost of care in their analyses . OBJECTIVE: To compare the effectiveness and cost of first-line with second-line antibiotics for the treatment of acute uncomplicated sinusitis in adults . DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using a pharmaceutical database containing demographic, clinical (International Classification of Diseases, Ninth Revision), treatment, and charge information for 29 102 adults with a diagnosis of acute sinusitis receiving initial antibiotic treatment between July 1, 1996, and June 30, 1997 . MAIN OUTCOME MEASURES: Absence of additional claim for an antibiotic in the 28 days after the initial antibiotic, presence of a claim for a second antibiotic, serious complications of sinusitis, and direct charges and use for the acute sinusitis treatment . RESULTS: There were 17 different antibiotics prescribed in this study . The majority (59.5%) of patients received 1 of the first-line antibiotics . The overall success rate was 90.4% (95% confidence interval {CI}, 90.0%-90.8%) . The success rate for the 17 329 patients who received a first-line antibiotic was 90.1% and for the 11 773 patients who received a second-line antibiotic was 90.8%, a difference of 0.7% (95% CI, 0.01%-1.40%; P<.05) . There were 2 cases of periorbital cellulitis, one in each treatment group . The average total direct charge for patients receiving a first-line antibiotic was $68.98 and a second-line antibiotic was $135.17, a difference of $66.19 (95% CI, $64.95-$67.43; P<.001) . This difference was due entirely to the difference in charge of antibiotics and not other charges, such as professional fees, laboratory tests, or emergency department visits . CONCLUSIONS: Patients treated with a first-line antibiotic for acute uncomplicated sinusitis did not have clinically significant differences in outcomes vs those treated with a second-line antibiotic . However, cost of care was significantly higher for patients treated with a second-line antibiotic.

Med Clin (Barc), 2001 Oct 20, 117(12), 457 - 9
{Spinal tuberculosis: early surgical treatment combined with medical treatment}; Fuster S et al.; BACKGROUND: Spinal tuberculosis can produce kyphosis with neurologicaldeficit, despite antibiotic treatment . When there is no response to medical treatment, the recommended procedure is debridementand interbody fusion with bone autograft . The biological characteristicsof Mycobacterium tuberculosis do not prevent osteosynthesisof the infected bone from being performed . PATIENTS AND METHOD: Five patients with spinal tuberculosis and neurological deficitunderwent debridement, interbody fusion and anterior osteosynthesisin addition to medical treatment . In order to ensure stability, posterior fusion was also performed in three patients . All 5 patientsdisplayed weakness and paralysis of their lower extremities, two patients suffered an L4 radiculopathy, one developed paraparesiaand one was excluded due to a short follow-up . Mean value of vertebralkyphosis was 22,8 degrees and mean follow-up was 3,1 years . RESULTS: No patient had septic loosening or progression of the disease . Correction of kyphosis was 104,5% postoperatively and 80,5% atthe end of follow-up . All patients, apart from one with an L4radiculopathy, exhibited neurological recovery . CONCLUSIONS: Anterior instrumentation allows spinal decompression, septic focusdebridement, deformity correction and autologous bone grafting.In severe kyphotic flattening, it is advisable to associate alimited posterior arthrodesis . When pathological fractures appearor there is no response to antibiotic treatment, the combinationof medical and surgical treatment improves patients' outcome.

Am J Respir Crit Care Med, 2001 Oct 1, 164(7), 1213 - 20
Inosine reduces systemic inflammation and improves survival in septic shock induced by cecal ligation and puncture; Liaudet L et al.; Inosine is a naturally occurring purine formed from the breakdown of adenosine . Here we have evaluated the effects of inosine in a murine model of polymicrobial sepsis induced by cecal ligation and puncture (CLP) . Mice subjected to CLP were treated with either inosine (100 mg/kg, intraperitoneally) or vehicle 1 h before and 6 h after CLP . After 12 h tumor necrosis factor alpha, interleukin 6 (IL-6), and IL-10 were measured in plasma . Biochemical markers of organ damage, liver NAD+/NADH (indicator of the mitochondrial redox state), plasma nitrate, tissue myeloperoxidase (MPO, indicator of neutrophil accumulation) and malondialdehyde (MDA, indicator of lipid peroxidation), liver and lung chemokines (macrophage inflammatory protein 1alpha {MIP-1alpha} and MIP-2), and ex vivo vascular reactivity in aortic rings were also measured . Mice treated with inosine had significantly lower levels of circulating cytokines . Organ damage was significantly reduced by inosine treatment, which was associated at the tissue level with an increased hepatic NAD+/NADH ratio, decreased MPO activity in the lung, reduced MDA formation in the gut and liver, and decreased MIP-1alpha and MIP-2 in the lung and liver . Furthermore, inosine significantly improved endothelium-dependent relaxant responses of aortic rings . These effects were associated with significant improvement of the survival of CLP mice treated with inosine, an effect that was still observed when inosine treatment was delayed 1 h after CLP, especially when it was associated with appropriate antibiotic treatment . Thus, inosine reduced systemic inflammation, organ damage, tissue dysoxia, and vascular dysfunction, resulting in improved survival in septic shock.

Int J Antimicrob Agents, 2001 Sep, 18(3), 223 - 9
Antibiotic therapy of ventilator-associated pneumonia--a reappraisal of rationale in the era of bacterial resistance; Sintchenko V et al.; Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICU) . Resistance patterns seen in ICUs suggest that prescribing recommendations should be reappraised to limit practices engendering resistance to large families of antibiotics . Despite concern surrounding the use of antibiotics in the management of VAP, there is limited evidence to assist the clinician in making decisions about the indications for such therapy, the selection of the correct antibiotic(s), the timing of initiation of therapy and its duration . The high amount of antibiotic use, in combination with the low grade colonisation of patients with multi-resistant pathogens at the time of admission, turns the ICU into an environment where antibiotic policy is likely to have an effect on the resistance problem . Opinions are changing as to the validity of invasive techniques in guiding prescribing decisions . Invasive and semi-invasive diagnostic testing increases physician confidence in the diagnosis and management of VAP and helps to limit or discontinue antibiotic treatment.

Monaldi Arch Chest Dis, 2001 Jun, 56(3), 276 - 80
Atypical pathogens and asthma: can they influence the natural history of the disease?
Blasi F, Cosentini R, Tarsia P, Capone P, Allegra L.
The association between respiratory infections and asthma exacerbations was first observed in the early '70s . In particular, the role of viral upper respiratory tract infections has been evaluated both in pediatric and adult populations . More recently, evidence of Mycoplasma and Chlamydia pneumoniae involvement in asthma attacks has been reported . These pathogens are also involved in chronic asthma, and both in vitro and animal model studies indicate that atypical agents may play a role in the pathogenesis of the disease . Further research is required to determine whether specific antibiotic treatment may alter the natural history of asthma.

Arch Pediatr Adolesc Med, 2001 Oct, 155(10), 1137 - 42
Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media; Pichichero ME et al.; BACKGROUND: The distinction between acute suppurative otitis media (AOM) and otitis media with effusion (OME) is important for antibiotic treatment decisions . Tympanocentesis may be useful in the diagnosis of AOM in selected patients . OBJECTIVES: To assess physician accuracy in diagnosing AOM and OME from physical examination findings and technical competence in performing tympanocentesis . DESIGN AND SUBJECTS: Five hundred fourteen pediatricians and 188 otolaryngologists viewed 9 different videotaped pneumatic otoscopic examinations of tympanic membranes during a continuing medical education course . Diagnostic differentiation of AOM, OME, and a normal tympanic membrane was ascertained . An infant mannequin model was used to assess the technical proficiency of performing tympanocentesis on artificial tympanic membranes . RESULTS: Overall, the average correct diagnosis by pediatricians was 50% (range, 25%-73%) and by otolaryngologists was 73% (range, 48%-88%) . Pediatricians and otolaryngologists correctly recognized the absence of normality 89% to 100% and 93% to 100% of the time, respectively, but overdiagnosed AOM in 7% to 53% (mean, 27%) and in 3% to 23% (mean, 10%) of examinations . Performance of tympanocentesis was optimally performed by 89% of otolaryngologists and by 83% of pediatricians . CONCLUSIONS: The use of video-presented examinations to assess diagnostic ability suggests that AOM and OME may be misdiagnosed often . Interactive continuing medical education courses with simulation technology may enhance skills and improve diagnostic accuracy and treatment paradigms.

Antimicrob Agents Chemother, 2001 Nov, 45(11), 3001 - 8
Effects of azithromycin and rifampin on Chlamydia trachomatis infection in vitro; Dreses-Werringloer U et al.; An in vitro cell culture model was used to investigate the long-term effects of azithromycin, rifampin, and the combination of azithromycin and rifampin on Chlamydia trachomatis infection . Although standard in vitro susceptibility testing indicated efficient inhibition by azithromycin, prolonged treatment did not reveal a clear elimination of chlamydia from host cells . Chlamydia were temporarily arrested in a persistent state, characterized by culture-negative, but viable, metabolically active chlamydia, as demonstrated by the presence of short-lived rRNA transcripts . Additionally, azithromycin induced generation of aberrant inclusions and an altered steady-state level of chlamydial antigens, with the predominance of Hsp60 protein compared to the level of the major outer membrane protein . Treatment with azithromycin finally resulted in suppression of rRNA synthesis . Chlamydial lipopolysaccharide and processed, functional rRNA were detectable throughout the entire incubation period . These in vitro data show a good correlation to those from some recent clinical investigations that have reported on the persistence of chlamydia, despite appropriate antibiotic treatment with azithromycin . Rifampin was highly active by in vitro susceptibility testing, but prolonged exposure to rifampin alone for up to 20 days resulted in the emergence of resistance . No development of resistance to rifampin was observed when chlamydia-infected cells were incubated with a combination of azithromycin and rifampin . This combination was shown to be more efficient than azithromycin alone, in that suppression of rRNA synthesis occurred earlier . Thus, such a combination may prove more useful than azithromycin alone.

Turk J Pediatr, 2001 Jul-Sep, 43(3), 205 - 9
Overdiagnosis of pneumonia in children; Anadol D et al.; The aim of this study was to reevaluate patients diagnosed as pneumonia in our outpatient clinic in an effort to determine whether these patients really had pneumonia and needed antibiotic therapy . Over a 14-month period, 119 children who were diagnosed as pneumonia were prospectively evaluated . In order to find a relationship, specificity and sensitivity were defined . The diagnosis of pneumonia was ruled out in 48 of the 119 (40%) patient included . An incorrect diagnosis of pneumonia was made in 40% of cases and antibiotics were prescribed unnecessarily in 85% . Tachypnea, which had a specificity of 99% and sensitivity of 61%, was the most important criteria in diagnosing pneumonia . We believe that children who present with cough only do not always need antibiotic treatment . Tachypnea and auscultation findings are important criteria for diagnosing and treating pneumonia.

Cornea, 2001 Oct, 20(7), 727 - 30
Compression sutures in the management of corneal transplant wound infections; Meisler DM et al.; PURPOSE: To report the usefulness of compression sutures in the management of three cases of bacterial wound infections in corneal transplants . METHODS: Interventional case series . RESULTS: All three cases of wound dehiscence and perforation resulting from bacterial wound infections were successfully treated with placement of compression sutures with concurrent topical antibiotic treatment . CONCLUSION: The placement of compression sutures is a successful surgical technique to reestablish corneal transplant wound integrity compromised by infection.

Dermatology, 2001, 203(2), 168 - 70
Multilesional primary cutaneous diffuse large B-cell lymphoma responsive to antibiotic treatment; Hofbauer GF et al.; Borrelia burgdorferi infection has been implicated in cutaneous B-cell lymphoma . We report a case of multilesional primary cutaneous large B-cell lymphoma without extracutaneous spread in a patient with elevated B . burgdorferi titers . After antibiotic therapy, clinical remission and a subsequent drop in B . burgdorferi antibody titers were obtained .

Ned Tijdschr Geneeskd, 2001 Sep 15, 145(37), 1773 - 7
{'Evidence-based' perioperative antibiotic prophylaxis policy in Belgian hospitals after a change in the reimbursement system}; Goossens H et al.; The costs of antibiotics in Belgian hospitals are nearly fully reimbursed by the health insurance . Such a situation is not conductive to rational drug use . A new reimbursement system for perioperatively-administered antibiotics in Belgian hospitals was implemented in May 1997 by Royal Decree . A reimbursement code for antibiotic use was linked to the reimbursement of surgical interventions . This code represents a reimbursement which covers 75% of the cost of perioperative prophylaxis based on optimal indication, dose, and duration as recommended by international and Belgian consensus guidelines . The actual antibiotic prescribed during the 72-hour perioperative period (the day before, during and after surgery) is reimbursed at only 25% of its full cost . Thus, if the perioperative prophylactic antibiotic regimen complies with the evidence-based guidelines, the costs of antibiotic prescribing will be fully reimbursed by the health insurance (75% of the standard +25% of the actual costs) . The new reimbursement system does not apply to antibiotics which are prescribed for treatment of intercurrent infections; these antibiotics continue to be fully reimbursed . Annual expenditures for antibiotics, for both antibiotic treatment and prophylaxis, nationwide and per hospital, have shown marked improvements in perioperative antibiotic use after the decree was implemented . Surgeons' adherence to the evidence-based standard of prophylactic antibiotic use has improved over time . In conclusion, rapid implementation of the perioperative antibiotic prophylaxis policy was achieved through changes in the reimbursement of antibiotics for surgery patients.

J Antimicrob Chemother, 2001 Oct, 48(4), 535 - 40
Departmental consumption of antibiotic drugs and subsequent resistance: a quantitative link; Leibovici L et al.; OBJECTIVE: To look for a quantitative model linking departmental consumption of antibiotic drugs to the subsequent isolation of resistant hospital-acquired coliform pathogens . MATERIALS AND METHODS: Included in the study were all patients with hospital-acquired bloodstream infections caused by a coliform pathogen, detected in six departments of internal medicine of one university hospital during the period 1991-1996, who had not been hospitalized in the month before the infection (n = 394) . Departmental consumption of antibiotics in the year before the infection {expressed as defined daily dosages (DDD)/100 patient days}, antibiotic treatment given to the individual patient before the infection, the day of hospital stay on which the infection occurred, and the department and the calendar year were all included in a logistic model to predict the isolation of a resistant pathogen . We looked at five drugs: gentamicin, amikacin, cefuroxime, ceftazidime and ciprofloxacin . RESULTS: Five logistic models were fitted for the resistance to each of the antibiotic drugs . The multivariable-adjusted odds ratios for a pathogen resistant to the specific antibiotic were 1.03 {95% confidence interval (CI) 0.70-1.50} for gentamicin, 1.80 (95% CI 1.00-3.24) for amikacin, 1.12 (95% CI 1.02-1.23) for cefuroxime, 1.45 (95% CI 1.19-1.76) for ceftazidime and 1.06 (95% CI 0.57-1.97) for ciprofloxacin, per 1 DDD/100 patient days . CONCLUSIONS: The departmental consumption of cephalosporin drugs and amikacin in six autonomous departments of medicine in the same hospital was associated with a measurable and statistically significant increase in the probability of infection caused by a resistant pathogen.

Pol Merkuriusz Lek, 2001 Jul, 11(61), 44 - 8
{The value of the ultrasonography and computed tomography in diagnosis and monitoring of treatment of renal abscesses in children}; Zaleska-Dorobisz U et al.; A retrospective study of 14 patients from 2 to 13 years old with renal abscess was performed . We evaluated the diagnostic value of ultrasonography (US) and computed tomography (CT) in diagnostic investigation and treatment of renal abscess, which have changed during the past ten years from classic surgical treatment to percutaneous drainage . US and CT have revealed the diagnosis by showing a hypoechogenic or hypodense mass in all 14 patients . All had an intensive course of antibiotic treatment . In 10 of them the abscess were drained percutaneously by US guided drainage . Percutaneous drainage was unsuccessful in 2 patients, who subsequently underwent classic surgical exploration, incision and drainage for uncontrolled infection . We conclude that US and CT greatly facilitate the diagnosis and permit the percutaneous drainage of renal abscess in paediatric age group, which benefits from this minimally invasive therapy.

Gan To Kagaku Ryoho, 2001 Sep, 28(9), 1213 - 35
{Recent progress in the treatment of malignant lymphoma}; Ogura M; The present state of the art and developments in the treatment for Hodgkin's disease (HD), follicular lymphoma (FL), MALT lymphoma, and aggressive non-Hodgkin's lymphoma are reviewed . Four courses of ABVD therapy (ABVd therapy in Japan) followed by involved-field irradiation (IFRT), and 6 to 8 courses of ABVD (ABVd in Japan) are the current state art of the therapy for early stage HD and advanced stage HD, respectively . High-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HSCT) is also the state of the art for refractory or relapsed HD within 1 year after complete remission (CR) produced by polychemotherapy . The prognosis of the patients with 3 or more International Prognostic Scores (IPS) is poor . New intensified polychemotherapy or auto-HSCT as up-front setting is under randomized phase III clinical trial in Europe and the USA . There is no state of the art therapy for indolent lymphoma including FL, or MALT . Promising results were reported from clinical studies using new anti-lymphoma drugs such as rituximab, iibritumomab, or purine analogs (cladribine and fludarabine), and auto-HSCT with effectively purged stem cells or allogeneic HSCT . These therapeutic strategies hold a possibility of cure for indolent lymphomas . Antibiotic treatment for Helicobacter pylori-positive localized gastric MALT lymphoma is the state of the art therapy . However, there is no standard therapy for advanced stage MALT lymphoma . Risk adapted therapy using the International Prognostic Index is essential for the treatment of aggressive NHL . Three courses of CHOP followed by IFRT for localized aggressive NHL and 8 courses of CHOP for the low-risk group of advanced stage aggressive NHL are the state of the art therapies, respectively . High-dose chemotherapy with auto-HSCT is also the state of the art for sensitive relapse patients with aggressive NHL . Although some clinical studies suggested that high-dose chemotherapy with auto-HSCT as up-front setting for high-intermediate or high-risk group aggressive NHL is more effective than conventional chemotherapy, the efficacy remains to be determined . The development of new therapeutic strategies with combined use of molecular targeting drugs such as rituximab, or new anti-lymphoma drugs such as purine analogs, and HSCT is desired for more effective therapy for refractory lymphomas.

J Periodontol, 2001 Sep, 72(9), 1241 - 5
Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis; Purucker P et al.; BACKGROUND: Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported . The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP . METHODS: After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups . Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later . Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group) . RESULTS: In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG) . However, there was no statistically significant difference between the 2 groups in pocket reduction . Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG) . The difference in CAL gain between the 2 groups was not statistically significant . At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL . The frequency and percentage of bleeding sites decreased significantly in both groups . At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG) . CONCLUSIONS: These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.

J Infect Dis, 2001 Oct 15, 184(8), 1065 - 9 Epub 2001 Aug 31.
Role of Candida in antibiotic-associated diarrhea; Krause R et al.; To quantitatively assess the role of Candida species in antibiotic-associated diarrhea (AAD), stool samples from a total of 395 patients and control subjects were cultured in differential isolation medium: 98 patients had AAD, 93 patients were taking antibiotics but did not have diarrhea (A(+)D(-)), 97 patients were not taking antibiotics but had diarrhea (A(-)D(+)), and 107 patients were control subjects (A(-)D(-)) . In addition, secreted aspartyl proteinase (Sap) production was tested . In AAD patients, Candida positivity (77/98) and Candida overgrowth (62/98) were not different from that among A(+)D(-) patients (75/93 {P= .860} and 52/93 {P= .375}, respectively) . Candida overgrowth among A(-)D(+) patients (40/97, P= .003) was less frequent than among AAD patients, but Candida positivity was not different (80/97, P= .612) . In control subjects, Candida positivity and overgrowth were less common than in all other groups . Production of Sap did not differ between patients with AAD and control subjects (P= .568 and P= .590, respectively) . Data indicate that elevated Candida counts are a result of antibiotic treatment or diarrhea rather than a cause of AAD.

J Dairy Sci, 2001 Sep, 84(9), 2010 - 7
Evaluation of a systemic antibiotic treatment of toxic puerperal metritis in dairy cows; Drillich M et al.; The objective of this study was to evaluate the efficacy and economic efficiency of a systemic treatment of toxic puerperal metritis in dairy cows with ceftiofur . Cows with abnormal vaginal discharge at a postpartum examination (d 4 to 6 after calving) and a rectal temperature > or = 39.5 degrees C were assigned to three treatment groups . Cows in group 1 (n = 70) received 600 mg of ceftiofur intramuscularly (i.m.) on 3 consecutive days . Cows in group 2 (n = 79) received an intrauterine treatment with antibiotic pills consisting of 2500 mg of ampicillin and 2500 mg of cloxacillin and an additional 6000 mg (i.m.) of ampicillin . This treatment was performed on 3 consecutive days . Cows in group 3 (n = 78) received the same intrauterine treatment as in group 2 . In addition, 600 mg of ceftiofur was administered i.m . on 3 consecutive days . Body temperature was recorded daily for 6 d after first treatment . There were no significant differences among the groups regarding clinical efficacy at d 6 after first treatment . The cure rates based on rectal temperatures declining to below 39.5 degrees C on d 6 after treatment were 82.9, 84.8, and 84.6% for groups 1, 2, and 3, respectively . Reproductive performance did not differ significantly between group 1 and groups 2 and 3 for any of the measures tested . A financial analysis with 87 different cost scenarios demonstrated that a systemic treatment of toxic puerperal metritis in cattle with ceftiofur is an effective alternative to the combination of local and systemic treatments.

Arch Ophthalmol, 2001 Sep, 119(9), 1254 - 7
Penetration of ofloxacin and ciprofloxacin into the aqueous humor of eyes with functioning filtering blebs: a randomized trial; Cantor LB et al.; OBJECTIVE: To determine concentrations of ofloxacin and ciprofloxacin hydrochloride in aqueous humor after topical or combined topical and oral administration in eyes with filtering blebs . DESIGN: A prospective, investigator-masked, randomized, controlled comparative study involving 36 eyes of 34 patients with functioning filtering blebs who were to undergo cataract surgery . Treatment groups received either topical ofloxacin or topical ciprofloxacin (instillation of 0.3% ophthalmic solution every 30 minutes for 4 hours before surgery), or a combined topical plus oral regimen (ciprofloxacin hydrochloride, four 100-mg tablets, or ofloxacin, one 400-mg tablet, administered 24-26, 12-14, and 2 hours preceding surgery) . The main outcome measure was antibiotic concentration measured by chromatographic separation and mass spectrometry of aqueous samples obtained during surgery . RESULTS: Topical antibiotic treatment yielded mean concentrations of ofloxacin, 0.75 microg/mL, and ciprofloxacin, 0.21 microg/mL, in aqueous . With combined topical and oral therapy, significantly more ofloxacin was measured than ciprofloxacin (3.84 microg/mL vs 0.35 microg/mL {P<.001}) . The combination regimen produced significantly greater ofloxacin levels than did topical therapy alone (P =.007) . CONCLUSIONS: Ofloxacin penetrates better than ciprofloxacin into the aqueous of eyes with filtering blebs, particularly after combined topical and oral administration, by which ofloxacin reaches more than a 10-fold greater concentration than does ciprofloxacin . Combined topical and oral therapy with ofloxacin may be beneficial in the treatment of bleb-associated infections.

Z Geburtshilfe Neonatol, 2001 Jul-Aug, 205(4), 143 - 6
{Total cervix occlusion--an efficient measure in prolapsed amniotic membranes in extreme prematurity?}; Artmann A et al.; BACKGROUND: We analysed retrospectively whether the total cervix occlusion implicates efficient the prolongation of pregnancy in patients with bulging fetal membranes during extreme prematurity . PATIENTS AND METHODS: Between 1993 and 1999 nineteen pregnant women (17 singleton and 2 twin pregnancies) with cervical incompetence and bulging membranes at 20 to 27 weeks' gestation (mean 24 weeks) underwent total cervix occlusion (TCO) at the Department of Obstetrics at the Technische Universitat of Munich after taking cervical cultures, prophylactic antibiotic treatment, tocolysis and induction of fetal lung maturity (after 33 weeks of gestational age) . RESULTS: Eleven of nineteen pregnancies were carried beyond 32 weeks' gestation . 6 of 21 fetuses, included 2 twin pregnancies died . Considering the perinatal mortality the mean prolongation of pregnancy was 9.4 weeks after total cervix occlusion . 9 of 19 pregnant women were delivered beyond 37 weeks of gestational age . CONCLUSION: Taking the small number and the lack of a randomized trial into consideration, these results implicate the total cervix occlusion as an efficient method in cases of bulging membranes during extreme prematurity . Nevertheless a thorough postoperative control and screening of infectious complications are required.

Am J Gastroenterol, 2001 Sep, 96(9), 2691 - 9
Expression of cytokines, inducible nitric oxide synthase, and matrix metalloproteinases in pouchitis: effects of probiotic treatment; Ulisse S et al.; OBJECTIVE: The efficacy of probiotic organisms in the treatment of pouchitis has been reported . In the present study, we evaluated the tissue levels of pro- and anti-inflammatory cytokines, nitric oxide synthase, and matrix metalloproteinases in control and inflamed pouches before and after antibiotic and probiotic treatment of patients with acute pouchitis . METHODS: Pouch biopsy samples were obtained from seven patients with pouchitis before and after antibiotic and probiotic treatment . Tissue samples from five patients with normal pouches were used as controls . Cytokines were determined by ELISA, matrix metalloproteinase activity was evaluated by zymograms, and nitric oxide synthase activity was determined by measuring arginine to citrulline conversion . RESULTS: Tissue levels of tumor necrosis factor a increased (p < 0.01) in pouchitis relative to uninflamed pouches and reduced after antibiotic and probiotic treatment . Also, interferon y and interleukin 1alpha (IL-1alpha) augmented in pouchitis, but their increase did not reach statistical significance . The latter, however, were lower (p < 0.05) after treatment with the antibiotics and probiotics . Tissue levels of IL-4 and IL-10 were unchanged in inflamed pouches and unaffected by antibiotic treatment . However, IL-10 increased (p < 0.05) after probiotic treatment . Moreover, inflamed pouches had higher levels of inducible nitric oxide synthase and gelatinase activities, which decreased after treatment . CONCLUSIONS: The ability of antibiotic and probiotic treatments to increase tissue levels of IL-10, at a higher level than those observed in control pouches, and to decrease, to levels present in control pouches, proinflammatory cytokine, inducible nitric oxide synthase, and matrix metalloproteinase activity may suggest a mechanism of action to explain the efficacy of this therapeutic regime in pouchitis.

Laryngoscope, 2001 Sep, 111(9), 1551 - 7
Fine-needle aspiration biopsy; Amedee RG et al.; OBJECTIVES: Fine-needle aspiration biopsy (FNAB) is a technique in which a fine needle is introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered . It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors . FNAB lends itself to the diagnosis of palpable head and neck masses, in particular, those that persist following antibiotic treatment . STUDY DESIGN/METHODS: This clinical state-of-the-art review article is intended to provide an overview of the clinical use of FNAB in the management of head and neck masses . Relevant case histories are used to illustrate this point . RESULTS: Fine-needle aspiration biopsy has a high overall diagnostic accuracy of 95% for all head and neck masses, 95% for benign lesions, and 87% for malignant ones . CONCLUSIONS: There are virtually no contraindications, and complications are minimal . Advantages of FNAB are that it is safe and simple, it can be performed as an outpatient procedure, and it is well tolerated by patients . In the present managed care environment, it also proves cost-effective . The diagnosis is readily known to the clinician, and appropriate treatment modalities can be discussed with the patient . It is recommended as a first line of investigation in palpable head and neck masses.

Eur Cytokine Netw, 2001 Jul-Sep, 12(3), 420 - 9
Local administration of interleukin-1beta for the treatment of lung abscesses induces neutrophil activation and changes in proinflammation cytokine production; Simbirtsev A et al.; Interleukin-1 (IL-1) is a potent immunostimulatory molecule with broad range biological activity that limits its systemic application in humans . Alternatively, IL-1 can be applied locally, directly to the inflammatory site for stimulation of local defense mechanisms, without activating an acute phase response . IL-1beta preparations have been successfully used for local therapy of patients with purulent bacterial lung abscesses who were resistant to usual antibiotic treatment . IL-1beta was applied directly to the abscess cavity at a concentration of 10 ng/ml, once a day for 7 days . Before IL-1beta administration, local leukocyte functional activity was significantly reduced compared to the same activity in neutrophils isolated from the peripheral blood of the same patient . Local application of IL-1beta led to increases in adhesion, chemotaxis, oxygen radical production and phagocytosis of abscess fluid neutrophils . After local IL-1beta treatment, the concentration of IL-8 and TNF-alpha in the abscess fluids increased, while in nearly all patients levels of endogenous IL-1beta decreased . Immunocytochemical analysis showed that IL-1beta increased the numbers of cytokine-producing cells and induced proinflammatory cytokine production by neutrophilic granulocytes . According to the results obtained, the mechanism of the local immunostimulatory activity by IL-1beta is associated with the significant activation of neutrophilic granulocyte functions and changes in cytokine production at the inflammatory site . IL-1beta can be used as a highly effective immunotherapeutic drug when applied locally at adequate immunostimulatory dose levels.

J Microbiol Immunol Infect, 1999 Mar, 32(1), 52 - 6
Acute respiratory distress syndrome in Mycoplasma pneumonia: a case report and review; Chian CF et al.; Acute respiratory distress syndrome (ARDS) associated with Mycoplasma pneumoniae infection is unusual . We herein report a previously healthy young man who developed ARDS after 7 days of respiratory symptoms . M . pneumoniae infection was diagnosed by a positive test for M . pneumoniae IgM and a positive cold agglutinin test . The patient recovered eventually after receiving effective antibiotic treatment and mechanical ventilation for 8 days . Six additional cases of M . pneumoniae infection with ARDS were reviewed . M . pneumoniae should be considered as an etiological agent in a delayed onset of ARDS after pneumonia.

MMW Fortschr Med, 2001 Aug 23, 143(33-34), 30 - 2
{Prevention and therapy of diabetic foot syndrome . Preventing complications}; Hanke B et al.; Selective prevention and stage-orientated treatment of the diabetic foot syndrome helps to avoid late complications . A prerequisite is good blood sugar control, early use of ACE inhibitors, CSE inhibitors and--based on the vascular situation, with consideration given to indications--platelet aggregation inhibitors . Regular inspection of the feet must be taken seriously . Every diabetic should be taught the rules of behavior in young years . The primary physician is responsible for coordinating further treatment and early referral to specialized foot clinics . In the event of an infection, specific treatment of the usually polymicrobial infection should be initiated . Long-term antibiotic treatment is not to be recommended . Wherever necessary, the calculated antibiotic therapy must be corrected on the basis of the results of antibiotic sensitivity testing of swabs taken from deep tissue (better: exudate from the floor of the wound . In the case of superinfected ulcers, wound debridement by the specialist surgeon is considered a must . Also, late stages of diabetic foot can be successfully managed in specialized centers by "foot-relieving" measures, revascularization, arthrodesis, etc.

J Glaucoma, 2001 Aug, 10(4), 340 - 7
Management of blebitis by members of the American Glaucoma Society: a survey; Reynolds AC et al.; PURPOSE: To investigate the practice patterns among glaucoma subspecialists in the American Glaucoma Society regarding the management of blebitis . METHODS: An anonymous survey incorporating 14 questions regarding the management of blebitis was mailed to all current active American Glaucoma Society members, including provisional members, in October 1999 . RESULTS: A total of 319 physicians received the survey, and 204 members (64%) returned surveys . Sixty-nine percent of respondents do not ask their patients with functioning blebs to use topical antibiotics at home for early symptoms of blebitis . Thirty-four percent never or almost never obtain conjunctival cultures at the onset of isolated blebitis, whereas 44% always or usually do . Fifty-one percent prescribe a topical fluoroquinolone alone as the initial empirical treatment of isolated blebitis . Twenty-three percent use a fluoroquinolone in combination with one or two other antibiotics . Twenty-one percent choose a combination of fortified topical agents, usually including a fortified aminoglycoside, vancomycin, or cephalosporin . Thirty-one percent use fortified agents in some combination with or without a fluoroquinolone . Five percent prescribe some other single agent alone . Only 6% routinely use an oral antibiotic in cases of blebitis . Sixty-two percent use topical corticosteroids in conjunction with antibiotic treatment . Of these, 68% start them after initial antibiotic treatment is established or once improvement of blebitis is noted . Fifty-six percent indicated that a moderate or severe anterior chamber reaction, including fibrin, would prompt treatment as a possible endophthalmitis . In a persistently Seidel-positive bleb, 77% generally attempt surgical bleb revision . CONCLUSIONS: Methods of the management of blebitis differ among members of the American Glaucoma Society . Treatment recommendations generated from randomized clinical trials are needed.

Z Gastroenterol, 2001 Sep, 39(9), 797 - 800
A severe case of pneumatosis cystoides intestinalis with massive accumulation of gas outside the gastrointestinum; Tato F et al.; We report an unusually severe case of pneumatosis cystoides intestinalis in an adult female patient undergoing chemotherapy for lymphoblastic crisis in chronic myelogenous leukemia . An impressive accumulation of gas was not only detected within the intestinal wall and mesentery but also in the peritoneum, retroperitoneum, mediastinum and cervical subcutaneous tissue . The patient was almost asymptomatic and fully recovered within a few days of treatment . In addition to chemotherapy, the patient was receiving trimethoprim/sulfamethoxazole for pneumocystis carinii pneumonia and lactulose for constipation . Mucosal damage due to chemotherapy and depletion of tetrahydrofolic acid, changes in bowel flora induced by antibiotic treatment, and the intake of unabsorbable carbohydrates may be responsible for the severity of the disease.

Southeast Asian J Trop Med Public Health, 2001 Jun, 32(2), 397 - 401
Mycoplasma Pneumoniae infection in Malaysian children admitted with community acquired pneumonia; Chan PW et al.; Mycoplasma pneumoniae is increasingly recognized as an important cause of community acquired pneumonia (CAP) in children . We determined the importance of M . pneumoniae as a causative agent in 170 children aged 1 month to 15 years who were hospitalized with CAP over a 6-month period . The diagnosis of M . pneumoniae infection was based on serological evidence obtained by a particle agglutination test (SERODIA-MYCO II) . A positive serological diagnosis was made if the acute phase serum titer was more than 1:160 or paired samples taken 2-4 weeks apart showed a four-fold or greater rise in the serum titer . M . pneumoniae was identified as the causative agent in 40 (23.5%) children . Children with M . pneumoniae infection were more likely to be older than 3 years (OR 4.0 95%CI 1.8-9.1, p<0.001), Chinese (OR 4.3 95%CI 2.0-8.9, p<0.001), have a duration of illness longer than 7 days prior to admission (OR 6.0 95%CI 2.7-13.5, p<0.001) and have perihilar interstitial changes on chest X-ray (OR 4.6 95%CI 2.2-9.9, p<0.001) . A significant number of hospital admissions for CAP in Malaysian children can be attributed to M . pneumoniae . It is important to identify these children so as to administer the most appropriate antibiotic treatment.

East Mediterr Health J, 2000 Mar-May, 6(2-3), 326 - 32
{Essential drugs: availability and prescription in Monastir (Tunisia) health district}; Ben Salem K et al.; Shortages in the availability of some drugs are sometimes noted in primary health care (PHC) centres in spite of the steady increase in the drug budgets in Tunisia . We conducted a survey therefore in 1998 in the health district of Monastir to study the availability of certain essential drugs (n = 15) in PHC centres and the main features of the drug prescription . We found that the drugs lacking were generally those prescribed for chronic diseases and as well as oral antibiotics . Antibiotic treatment constituted 71.8% of public prescriptions and 32.3% of these prescriptions were for an injectable treatment.

J Gastroenterol Hepatol, 2001 Aug, 16(8), 872 - 5
Brachyspira aalborgi infection in four Australian children; Heine RG et al.; AIM: The clinical presentation of four children and adolescents (two males and two females with a mean age of 12.4 years; range 9-16 years) with colorectal spirochetosis is discussed . RESULTS: Symptoms included persistent diarrhea (n = 2), rectal bleeding (n = 1) and abdominal pain (n = 2) . In all patients, colorectal spirochetosis was an unanticipated finding on colonic histology, and the presence of spirochetes was confirmed by the use of electron microscopy . Spirochetes were identified as Brachyspira aalborgi by using PCR amplification of the bacterial 16S rRNA and nicotinamide adenine dinucleotide oxidase sequences in all four patients . No other enteric pathogens were found . CONCLUSIONS: Although all patients appeared to respond to antibiotic treatment, the clinical significance of B . aalborgi as a human pathogen requires further investigation.

J Infect Dis, 2001 Oct 1, 184(7), 870 - 8 Epub 2001 Aug 30.
Antibody response to IR6, a conserved immunodominant region of the VlsE lipoprotein, wanes rapidly after antibiotic treatment of Borrelia burgdorferi infection in experimental animals and in humans; Philipp MT et al.; Invariable region (IR)(6), an immunodominant conserved region of VlsE, the antigenic variation protein of Borrelia burgdorferi, is currently used for the serologic diagnosis of Lyme disease in humans and canines . A longitudinal assessment of anti-IR(6) antibody levels in B . burgdorferi-infected rhesus monkeys revealed that this level diminished sharply after antibiotic treatment (within 25 weeks) . In contrast, antibody levels to P39 and to whole-cell antigen extracts of B . burgdorferi either remained unchanged or diminished less . A longitudinal analysis in dogs yielded similar results . In humans, the anti-IR(6) antibody titer diminished by a factor of > or =4 in successfully treated patients and by a factor of <4 in treatment-resistant patients . This result suggests that the quantification of anti-IR(6) antibody titer as a function of time should be investigated further as a test to assess response to Lyme disease therapy or to determine whether a B . burgdorferi infection has been eliminated.

Eur J Pediatr, 2001 Aug, 160(8), 483 - 91
Respiratory tract infections by Mycoplasma pneumoniae in children: a review of diagnostic and therapeutic measures; Ferwerda A et al.; This review discusses the current knowledge on laboratory tests and treatment of respiratory tract infections caused by Mycoplasma pneumoniae (MP) in children . MP infection is endemic in most areas of the world . The highest incidence is seen in children aged between 3 and 14 years . Most infections are mild and non-pneumonic . Parapneumonic complications of MP pneumonia are rare . Complications are described affecting the skin, central nervous system, kidneys, heart, muscles and the eyes . To diagnose an acute MP infection in children, a combination of PCR and IgM serology is sensitive and convenient . In both tests it is possible to obtain a result in 1 to 2 days . As a consequence, adequate antibiotic treatment can be prescribed to the child . Macrolides are the first choice in treatment of MP infection in children . CONCLUSION: The most sensitive and rapid test to diagnose a Mycoplasma pneumoniae infection in children is a combination of nasopharyngeal polymerase chain reaction and IgM enzyme immunoassay . The treatment of choice in children is a macrolide.

Bone Marrow Transplant, 2001 Aug, 28(3), 259 - 64
Glycosylated vs non-glycosylated granulocyte colony-stimulating factor (G-CSF)--results of a prospective randomised monocentre study; Bonig H et al.; The discovery of the haematopoietic growth factor granulocyte colony-stimulating factor (G-CSF) has reduced infection-related morbidity in cancer patients by alleviating post-chemotherapy neutropenia . Two formulations of recombinant human (rh) G-CSF, one glycosylated and one non-glycosylated, are available . The glycosylated form, lenograstim, possesses at least 25% greater bioactivity in vitro . Some comparative studies into the preparation's potential to mobilise haematopoietic stem cells suggest a similar advantage . In the light of the great clinical importance of G-CSF, we have performed the first prospective, randomised, crossover study on children with chemotherapy-induced neutropenia . G-CSF (250 microg/m(2)) was started 1 day after the chemotherapy block, and was administered until a WBC >1500/microl was achieved on 3 successive days . Thirty-three G-CSF cycles from 11 patients (16 lenograstim, 17 filgrastim) were studied . They were investigated for duration of very severe (WBC <500/microl, 9 vs 9.5 days, lenograstim vs filgrastim, median) and severe leukopenia (WBC <1000/microl, 11 vs 11 days), infections (CRP >5 mg/dl, 5 vs 5.5 days), infection-related hospital stay (11 vs 9 days) and antibiotic treatment (9 vs 9 days) . Statistical evaluation by paired analysis could not detect any difference between treatment groups; the median difference for all end-points was zero . In summary, at least at 250 microg/m(2), in terms of their clinical effect on neutropenia, the two G-CSF preparations appear to have identical activity.

Cutis, 2001 Aug, 68(2), 127 - 9
Infantile acute hemorrhagic edema of the skin; Paradisi M et al.; Infantile acute hemorrhagic edema (AHE) of the skin is an uncommon form of cutaneous leukocytoclastic vasculitis that occurs in children younger than 3 years . We describe a 10-month-old boy with AHE, in whom the disease appeared after antibiotic treatment for an acute respiratory illness . AHE presented with fever, acral edema, and rosette-shaped purpuric plaques on the face and limbs . The causes of AHE are unclear, as is its nosologic position . Some authors consider the disease as a purely cutaneous form of Henoch-Schonlein purpura, and others believe that AHE should be regarded as a distinct clinicobiologic entity within the spectrum of leukocytoclastic vasculitis.

Acta Obstet Gynecol Scand, 2001 Aug, 80(8), 753 - 6
Antibiotic treatment for threatened abortion during the early first trimester in women with previous spontaneous abortion; Ou MC et al.; BACKGROUND: We retrospectively examined the usefulness of antibiotic therapy for management of first-trimester threatened abortion in women with previous spontaneous abortion . METHODS: From 1993 through 1999, women with first-trimester threatened abortion received antibiotic therapy . Only those with gestational age less than 9 weeks and previous spontaneous abortion were included in this analysis . Women with mild abdominal cramping received amoxicillin plus erythromycin for 1 week; those with severe abdominal pain received amoxicillin plus clindamycin for 1 week . Recurrence was documented on the basis of either lower abdominal pain or vaginal bleeding . RESULTS: Of the 23 women included, 15 (65%) had abnormal vaginal flora (a score above 4, Nugent's criteria) . Seven of 16 women who received amoxicillin plus clindamycin and three of seven who received amoxicillin plus erythromycin had complete resolution of lower abdominal pain and vaginal bleeding without recurrence (p=1) . The recurrence rate was higher, though not significantly, in women with abnormal bacterial vaginal flora (8/15 vs . 2/8, p=0.379) . Twenty-two (96%) of the 23 pregnancies were carried to term, with no identifiable neonatal anomalies . CONCLUSIONS: These results suggest the usefulness of early antibiotic therapy in preventing pregnancy loss in women with threatened abortion early in the first trimester, and warrant further clinical trials.

JPEN J Parenter Enteral Nutr, 2001 Sep-Oct, 25(5), 282 - 5
Metastasis of head and neck carcinoma to the site of percutaneous endoscopic gastrostomy: case report and literature review; Sinclair JJ et al.; BACKGROUND: Patients with head and neck cancer often need a percutaneous endoscopic gastrostomy to provide adequate nutrition because of inability to swallow after tumor radiation therapy . However, metastasis of the original tumor to the gastrostomy exit site may occur . METHODS: We describe the case of a 61-year-old man with stage III (T2 N1) squamous cell carcinoma of the tongue in whom a PEG tube was placed to circumvent anticipated difficulties in swallowing after radiation therapy . We also compare this case with similar cases in the literature . RESULTS: Soreness and erythema near the gastrostomy site reported by the patient were diagnosed as cellulitis, and two courses of antibiotic treatment were prescribed . However, a biopsy showed that the original squamous cell carcinoma had metastasized to the gastrostomy exit site . The "pull" method of tube placement had been used in this patient and in all 19 cases of metastasis reported in the literature . CONCLUSIONS: Metastatic cancer should be considered in patients with head and neck cancer who have unexplained skin changes at the gastrostomy site . Our experience with this case and review of the literature indicate that, in patients with head and neck cancer, "pull" procedures for placement of gastrostomy tubes may induce metastasis by direct implantation of tumor cells because of contact between the gastrostomy tube and tumor cells . Methods of tube insertion that avoid such contact are preferred.

Ugeskr Laeger, 2001 Aug 20, 163(34), 4571 - 3
{Antibiotic treatment of travellers' diarrhea}; Klinge L et al.; This review should be cited as: De Bruyn G, Hahn S, Borwick A . Antibiotic treatment for travellers' diarrhoea (Cochrane Review) . In: The Cochrane Library, Issue 1, 2001 . Oxford: Update Software . A substantive amendment to this systematic review was last made on 21 May 2000 . Cochrane reviews are regularly checked and updated if necessary . BACKGROUND: Traveller's diarrhoea is a syndrome frequently encountered in persons crossing an international boundary . Diarrhoea can lead to significant discomfort and interference with travel plans . Bacterial pathogens are a frequent course of this syndrome . Several antibiotics have been tested for efficacy in reducing the duration and severity of the illness . OBJECTIVES: The aims of the review were to access the effects of antibiotics on traveller's diarrhoea in relation to the duration of illness, severity of illness, and adverse effects of medications . SEARCH STRATEGY: The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched . Additional trials were identified by hand searching . Content experts were contacted . SELECTION CRITERIA: All trials in any language in which travellers older than five years were randomly allocated to treatment for acute non-bloody diarrhoea with antibiotics and where the causative organism is not known at allocation . DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data . MAIN RESULTS: Twenty published studies met inclusion and quality criteria for inclusion . Twelve studies were placebo-controlled . A meta-analysis for the primary outcome was not feasible . All of the ten trials reported a significant reduction in duration of diarrhoea in participants treated with antibiotics compared with placebo . Data from two trials demonstrated a small reduction for antibiotic treated patients in the number of unformed stools passed per each 24 hour period from randomisation up to 72 hours . Data from six trials demonstrated a greater number of participants being cured of diarrhoea by 72 hours (odds ratio {OR} 5.9, 95% confidence interval {CI} 4.06 to 8.57) . Data regarding side effects were available from five trials . There was wide variation in the prevalence of side effects reported in different trials . Persons taking antibiotics experienced more side effects than those taking placebo (OR 2.37, 95% CI 1.5 to 3.75) . REVIEWERS' CONCLUSION: Antibiotic treatment is associated with shorter duration of diarrhoea but higher incidence of side effects . Trials generally do not report duration of post-treatment diarrhoea using time-to-event analyses, and should do.

Acta Paediatr, 2001 Aug, 90(8), 868 - 72
Insulin-like growth factor-I and insulin-like growth factor-binding protein-3 in cystic fibrosis: a positive effect of antibiotic therapy and hyperalimentation; Lebl J et al.; Patients with cystic fibrosis (CF) are underweight and growth retarded . This study tested the link between serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-3 (IGFBP-3) levels and body height, nutritional status, pulmonary function tests and activity of inflammation in 92 subjects with CF (age 2.1-18.8 y) . It also analysed the effect of short-term antibiotic treatment and hyperalimentation on IGF-I and IGFBP-3 levels in 33 subjects (age 3.6-33.7y) on 41 occasions . Both IGF-I (-1.19 +/- 0.17 SD) and IGFBP-3 levels (-0.66 +/- 0.12 SD; both p < 0.0001 vs 0) were decreased in cross-sectional measurements . Their standardized values were inversely proportional to age (IGF-I: r = -0.23, p = 0.03; IGFBP-3: r = -0.29, p = 0.005) and positively correlated with SDS of height (IGF-I: r = 0.40, p < 0.0001; IGFBP-3: r = 0.36, p = 0.0005) and of mid-arm circumference (IGF-I: r = 0.39, p = 0.0001; IGFBP-3: r = 0.38, p = 0.0002), and with pulmonary function tests . After a short-term course of intensive antibiotic therapy and hyperalimentation, IGF-I normalized (from -0.66 +/- 0.20 to 0.00 +/- 0.25 SD; p < 0.0001) and IGFBP-3 increased (from -0.78 +/- 0.15 to -0.53 +/- 0.16 SD; p = 0.002) . IGFBP-3 correlated inversely with erythrocyte sedimentation rate (r = -0.40, p = 0.01) . CONCLUSION: The levels of IGF-I and IGFBP-3 are markedly decreased in patients with CF and tend to normalise after a short course of antibiotic treatment and hyperalimentation.

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