Comparison of Trimethoprim-Sulfamethoxazole,Cephadroxil and Cefprozil as Prophylaxis for Recurrent Urinary Tract Infections in Children

Abstract

The aim of this study was to compare the efficacy of prophylactic trimethoprimsulfamethoxazole (TMP/SMZ), cefprozil and cephadroxil treatments in children who have recurrent urinary tract infection, but no urinary tract pathology. After acute urinary tract infections (UTIs) were treated, the patients were divided into 3 groupsrandomly and TMP/SMZ was given to 21 patients, cephadroxil was given to 25 patients and cefprozil was given to 34 patients for 3 months—one dose at night. All patients were followed for 6 months following prophylaxis. The frequency of symptomatic UTIs among groups during prophylaxis was not statistically different, however the number of symptomatic UTIs in the cephadroxil group was lower than the other groups. Asymptomatic bacteriuria episodes were detected in TMP/SMZ and cefprozil groups, whereas no asymptomatic bacteriuria episodes were seen in the cephadroxil group. The number of patients with symptomatic UTI during the follow-up period was not different between groups, however all the asymptomatic bacteriuria episodes were encountered in the cefprozil group. In conclusion, in this study cephadroxil was found to be slightly superior to TMP/SMZ and cefprozil in preventing asymptomatic bacteriuria episodes and symptomatic UTIs in children with recurrent UTI and normal urinary tract system.     

拟诺卡菌感染1例并文献复习

目的 了解拟诺卡菌感染的临床特征及诊治方案.方法 对1例拟诺卡菌所致皮肤感染的患者资料进行分析.以"拟诺卡菌"为主题词检索万方、维普和中国知网数据库,以"Nocardiopsis"为主题词检索PubMed数据库,获取文献报道的拟诺卡菌所致感染的病例,筛选并总结分析病例资料.结果 福建医科大学附属泉州第一医院报道的1例病...     

Agents for the Decolonization of Methicillin-Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) bacteria are a common cause of hospital- and community-acquired infections. Persons may have asymptomatic colonization with MRSA in the nares, axillae, perineum, or groin. Since MRSA colonization often precedes infection, and infection is associated with significant morbidity and mortality, there is great interest in preventing the transmission of MRSA and decolonizing persons who harbor these bacteria. We provide an evidence-based review of MRSA decolonization agents. Our search strategy included the databases of the Cochrane Central Register of Controlled Trials, MEDLINE (1962-May 2008), and EMBASE (1980-May 2008). To identify unpublished trials, abstract books from appropriate major scientific meetings were hand searched, manufacturers were contacted, and pharmacology references were researched for available commercial products, formulations, adverse events, and dosing. The most extensive research in MRSA decolonization has been conducted with mupirocin, which is applied to the anterior nares 2–3 times/day for 5 days. Increased use is correlated to resistance development; therefore, routine decolonization is not prudent unless MRSA colonization is confirmed in the nares or other site. Retapamulin is under investigation for use in nares decolonization. If total body decolonization is necessary, bathing or showering with an antiseptic agent such as chlorhexidine gluconate is recommended in combination with mupirocin applied to the nares to improve the likelihood of eradication. Oral antibiotics have been evaluated for use in decolonization of the skin and nares but should be considered only in conjunction with topical agents and when all other decolonization attempts and environmental controls have been exhausted. Homeopathic and investigational agents may also be effective. Although mupirocin is the standard of care for decolonization of MRSA, several agents demonstrate efficacy and many merit further investigation.     

Ofloxacin versus co-trimoxazole in the treatment of typhoid fever in children

Ofloxacin has been successfully used in the treatment of typhoid fever and Salmonella infections of adults for many years. However, it has rarely been tried for the typhoid fever of children. In the present study, the therapeutic efficacy of ofloxacin in the treatment of typhoid fever in children was compared to that of co-trimoxazole. Out of 41 patients with bacteriologically documented typhoid fever, those with co-trimoxazole-resistant strains received 20 mg/kg ofloxacin twice daily for 10 days, and those with co-trimoxazole-susceptible bacteria were given 60 mg/kg co-trimoxazole twice daily for 10 days. Both groups were compared according to the clinical variables (apyrexia, resolution of gastrointestinal, central nervous system reactions and articular symptoms) and the time when cultures became negative. All patients in both groups were cured without relapse. Apyrexia, resolution of gastrointestinal, central nervous system reactions and articular symptoms were obtained in a significantly shorter time with ofloxacin than with co-trimoxazole (P < 0.05). The interval between onset of therapy and the time when cultures became negative was significantly shorter in the ofloxacin group than in the co-trimoxazole group (P = 0.005). Ofloxacin seems to be a good alternative in the treatment of typhoid fever caused by co-trimoxazole resistant salmonellae in children aged less than 16 years. It is well tolerated by the patients and it causes no side effects with short-term usage.     

Antimicrobial susceptibility of Stenotrophomonas maltophilia isolates from a Korean tertiary care hospital

We determined the antimicrobial susceptibility of 90 clinical isolates of Stenotrophomonas maltophilia collected in 2009 at a tertiary care hospital in Korea. Trimethoprim-sulfamethoxazole, minocycline, and levofloxacin were active against most of the isolates tested. Moxifloxacin and tigecycline were also active and hold promise as therapeutic options for S. maltophilia infections.     

Hypersensitivity to trimethoprim

We present two patients who experienced life-threatening immediate reactions and one patient who developed generalized urticaria following oral administration of trimethoprim (TMP) and sulfamethoxazole (SMX) combination. Skin prick tests with TMP were positive in the three patients. No patients reacted to skin prick tests with SMX. No significant levels of IgE antibodies to TMP were found by RAST in the serum of the patients. Normal subjects used as controls did not react to any of these tests. Single-blind, placebo-controlled oral challenges were positive with TMP and negative with SMX in all patients. These results suggest that the three patients developed type I hypersensitivity reactions to TMP. In our patients skin prick tests with TMP were useful in TMP hypersensitivity diagnosis.     

The Influence of Ofloxacin versus Trimethoprim-Sulfamethoxazole on the Aerobic Flora in Granulocytopenic Subjects

Summary

Ofloxacin (300 mg twice a day) and trimethoprim-sulfamethoxazole (TMP-SMZ) (160 mg trimethoprin and 800 mg sulfamethoxazole twice a day) were given prophylactically to 19 adult patients with acute leukemia undergoing induction chemotherapy. The influence of the two regimens on the bacterial aerobic flora was evaluated. Both of the prophylactic regimens conditioned the aerobic microflora of the patients. Both groups acquired new microorganisms, prevalently gram-positive cocci, but also gram-negative bacteria with the TMP-SMZ regimen. Both treatment groups acquired yeasts.     

2010年中国CHINET嗜麦芽窄食单胞菌耐药性监测

目的了解国内不同地区14所医院2010年临床分离嗜麦芽窄食单胞菌对抗菌药物的耐药性。方法收集14所医院2010年临床分离嗜麦芽窄食单胞菌1 661株,按统一方案、采用统一的材料、K-B法和判断标准(CLSI 2010年版)进行嗜麦芽窄食单胞菌的耐药性监测。结果 1661株嗜麦芽窄食单胞菌住院患者分离株占97.5%;门诊患者分离株仅占2.5%。60岁以上的老年患者分离株占63.8%,<18周岁患者的分离株占4.8%。主要是痰液等呼吸道分泌物分离者占83.0%;分离自血液、胸腹水、关节腔液、脑脊液等无菌体液者占4.7%。该菌对甲氧苄啶-磺胺甲(?)唑、左氧氟沙星和米诺环素的耐药率分别为11.2%、10.7%和3.4%,对头孢哌酮-舒巴坦的耐药率为13.8%。尿液分离株对甲氧苄啶-磺胺甲(?)唑和头孢哌酮-舒巴坦的耐药率为21.6%和33.3%,高于其他标本分离株耐药率,P<0.01。结论嗜麦芽窄食单胞菌主要分离自住院患者及痰液等呼吸道标本中,且多见于≥60岁的老年患者。该菌对多数抗菌药物固有耐药,但对CLSI推荐的甲氧苄啶-磺胺甲(?)唑、左氧氟沙星和米诺环素的耐药率低。头孢哌酮-舒巴坦对该菌亦有良好抗菌活性。应根据药敏试验结果合理选用治疗嗜麦芽窄食单胞菌感染的抗菌药物。