Fusidic acid for the treatment of antibiotic-associated colitis induced by clostridium difficile

Summary Twenty courses of fusidic acid were given to 16 patients with antibiotic-associated colitis caused byClostridium difficile. Fusidic acid was given in a dose of 0.5–1.5 g daily for seven to 21 days. Diarrhoea disappeared rapidly. Clinical relapse occurred after five courses and once when the patient was still on treatment. Clinical cure with persistence or reappearance of toxin occurred in four further patients. Nineteen courses of metronidazole were given to 19 patients who experienced six failures or relapses. Seven courses of vancomycin were given to five patients, three of whom had had relapse. Five patients healed without treatment. The relapses occurred only in old and prostrated patients. They often recurred several times in the same patient. 0.5 g of fusidic acid daily appears to be as effective as vancomycin and metronidazole for the treatment ofC. difficile-induced colitis.

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Fusidinsäure zur Behandlung der Antibiotika-assoziierten, durch Clostridium difficile induzierten Colitis

Zusammenfassung Sechzehn Patienten mit Antibiotikaassoziierter Colitis durchClostridium difficile wurden in 20 Therapiezyklen mit Fusidinsäure behandelt. Die Behandlung mit Tagesdosen von 0,5–1,5 g dauerte sieben bis 21 Tage. Die Diarrhöe sistierte rasch. In fünf Fällen trat nach der Therapie ein Rezidiv auf, in einem Fall unter der Therapie. Bei weiteren vier Patienten kam es zur klinischen Heilung, während jedoch die Toxinausscheidung persistierte oder rezidivierte. Im gleichen Zeitraum wurden bei 19 Patienten 19 Therapiezyklen von Metronidazol verabreicht, dabei kam es in sechs Fällen zum Therapieversagen oder zu Rezidiven. Bei fünf Patienten, von denen drei einen Rückfall erlitten hatten, wurde in sieben Therapiezyklen Vancomycin verabreicht. Bei fünf Patienten trat ohne Medikamente eine Heilung ein.

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This paper was presented in part at the 13th International Congress of Chemotherapy, August 1983, Vienna, Austria.     

Nosocomial bacterial eye infections in intensive-care units

A cluster of ten nosocomial eye infections occurred in three intensive-care units during an 18-month period. Nine of the ten patients were intubated, all were obtunded, and all had copious sputum production. The bacteria isolated from the patients' sputum samples and from the eyes were identical in nine cases. Pseudomonas aeruginosa caused six of the infections, including all those with complications (three corneal ulcers, two hypopyon, one opaque cornea, two corneal rupture). Three patients lost their sight. Only the left eye was infected in nine cases. In a prospective study of bacterial dispersion during tracheal suctioning of twenty intubated patients, patients with copious secretions had significantly higher bacterial colony counts on settle plates than those without. Colony counts were higher on the side opposite to the hand the nurse used to withdraw the catheter than on the same side. Nurses tended to withdraw the catheter diagonally across the patient's face, which may explain the selective involvement of the left eye.     

Fusidic acid treatment of HIV infection: no significant effect in a pilot trial

22 HIV-positive homosexual men were treated with fusidic acid tablets (500 mg t.i.d.) for a period of 2-12 months (mean 71/2). At entry, all had a CD4-count less than 500 X 10(6)/l, and/or a pokeweed mitogen lymphocyte proliferation response of less than 50% of 2 normal controls, and no overt opportunistic infections. No significant immunological changes were observed and no definite beneficial clinical effect. On the 10th-13th day of treatment, 12 of the patients developed fever and an itchy exanthema. The symptoms disappeared spontaneously in 9 patients. No hematological or biochemical side effects were seen. Thus, in this pilot study of fusidic acid therapy of HIV-infected men, no significant effect could be detected.     

Severe group B streptococcal eye infections in adults

Group B beta-haemolytic streptococci have not been described as causing invasive eye infection in adults. Our observation of 10 such infections in nine patients indicates that persons with damaged ocular surfaces are especially vulnerable.     

夫西地酸治疗37例耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎临床观察

目的 观察夫西地酸治疗耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎临床疗效.方法 选择耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎患者37例.应用夫西地酸钠0.5 g加入0.9%氯化钠注射液250 ml中,静脉滴注,1次/8 h,60 min滴入,连用10～14 d,观察其临床疗效、细菌清除率、肝肾功能变化、不良反应.结果夫西地酸治疗耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎临床治愈率为67.6%,有效率为86.5%.细菌清除率为62.2%;治疗过程中对肝肾功能无明显影响;无明显不良反应.结论 夫西地酸作为一种安全性较高的药物,对耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎效果较好.对于老年和(或)肾功能不良(或潜在不良)患者,可选择该药治疗.     

Fusidic acid disk diffusion testing of clostridium difficile can be calibrated using single-strain regression analysis

Single-strain regression analysis (SRA) was employed to calibrate the disk diffusion antibiotic susceptibility test for fusidic acid and Clostridium difficile. MIC determinations of 40 clinical isolates of C. difficile were performed with the E-test. The disk diffusion test was standardized according to the Swedish Reference Group for Antibiotics (SRGA). Disks used for SRA contained 1.5, 5, 15, 50 and 150 microg fusidic acid and the routine disk contained 50 microg fusidic acid. A control strain, ATCC 9689, was also tested. SRA constants A and B of the regression lines were calculated. This permitted the determination of zone breakpoints for C. difficile. When applying the pharmacological MIC S and R limits set by SRGA to the E-test results I strain of C. difficile was interpreted as resistant. Zone breakpoints corresponding to the pharmacological MIC limits and calculated using the mean SRA constants for the 40 clinical isolates lead to all strains being interpreted as susceptible. SRA calculations enable laboratories to set up calibrated disk tests with species-related and laboratory-specific interpretations.     

Fusidic acid and clindamycin resistance in community-associated,methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> infections in children of Central Greece

Introduction  

In Greece, fusidic acid and clindamycin are commonly used for the empiric therapy of suspected staphylococcal infections.     

Use of D-lactic acid measurements in the diagnosis of bacterial infections

This study explored the use of D-lactic acid as a marker for bacterial infections. D-Lactic was produced by frequently encountered human bacterial pathogens under anaerobic growth conditions; Bacteroides fragilis produced the largest amount. Orally administered D-lactic acid was absorbed from the intestines of rats and later found in measurable quantities in the blood and urine. Eunephric and anephric rats that received D-lactic acid intravenously showed similar quantities of this metabolite in the blood. These quantities are consistent with the distribution of D-lactic acid to total body water. Isolated liver and lung tissues from rats did not metabolize or produce D-lactic acid. Rats with experimentally induced, sublethal klebsiella peritonitis had D-lactic acidemia of 0.2 mM and 25.6 mM at 0 and 6 hr of infection, respectively. In a normal human, D-lactic acid was detected in the urine and blood after a subcutaneous injection of D-lactic acid, and pharmacokinetics of elimination similar to those of rats were found.     

Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients

BACKGROUND/AIM: Cefotaxime is considered the first-choice antibiotic for empirical treatment in cirrhotic patients developing bacterial infections. It has been suggested that amoxicillin-clavulanic acid could be an alternative to cefotaxime, particularly in patients developing bacterial infections while on prophylactic norfloxacin. The aim of the present study was to compare amoxicillin-clavulanic acid with cefotaxime in the treatment of bacterial infections in cirrhosis. METHODS: Ninety-six hospitalized cirrhotic patients with suspicion of bacterial infection were prospectively included and randomized into two groups: one group (n=48) received amoxicillin-clavulanic acid, first intravenously 1 g-0.2 g every 8 h, and then orally 500 mg-125 mg every 8 h, and the other group (n=48) received intravenous cefotaxime 1 g every 6 h. Patients were stratified for previous prophylaxis with norfloxacin and ascitic fluid infection. RESULTS: Sixteen patients were excluded from the analysis because bacterial infection was not demonstrated or because of secondary peritonitis. Therefore, 38 patients from the amoxicillin-clavulanic acid group and 42 from the cefotaxime group were finally analyzed. There were 24 ascitic fluid infections in each group. Infection resolution (86.8% vs 88%, 95% CI: -0.15 to 0.13, p NS), spontaneous bacterial peritonitis resolution (87.5% vs 83.3%, 95% CI: -0.15 to 0.24, p NS), duration of treatment, incidence of complications, time of hospitalization and hospital mortality were similar in both groups. Considering patients on prophylactic norfloxacin, infection resolution was also similar (100% vs 83.3%, 95% CI: -0.04 to 0.37, p NS). No adverse events were observed in either of the two groups. The cost of antibiotics was statistically lower in the amoxicillin-clavulanic acid group (p<0.001). CONCLUSIONS: Amoxicillin-clavulanic acid is as effective as cefotaxime in the treatment of bacterial infections in cirrhotic patients, but is less expensive and can be administered orally. These results suggest that amoxicillin-clavulanic acid is an effective alternative to cefotaxime for the empirical treatment of bacterial infections in cirrhosis.     

Symptomatic and asymptomatic infections of Demodex spp. in eye lashes of patients of different age groups

Demodex folliculorum and Demodex brevis were looked for on eyelashes sampled from 481 people, aged 3 through 96. The persons studied were divided into 9 age groups. Magnitude of the infection symptoms was assessed based on macroscopic changes of eye-lid edges and on interviews with patients. An increase of the prevalence of infection and intensification of the symptoms were observed to coincide with the age increase of the persons studied. No significant differences were demonstrated between the infection frequencies of women and men. Symptoms of ocular demodecosis were more frequent only in women of group III (aged 21-30) and group V (41-50) (p < 0.05).