Combination Of Clindamycin Research Articles

Prevention and treatment of bacterial vaginosis in pregnant women with isthmic-cervical insufficiency

Purpose of the study was to evaluate the effectiveness of clindamycin in combination with metronidazole and miconazole in complex therapy in pregnant women suffering from vaginal dysbiosis with ischemic-cervical insufficiency with threat of premature birth, which used an unloading obstetric pessary.Materials and methods. 100 pregnant women with bacterial vaginosis in the III trimester of pregnancy with isthmic-cervical insufficiency, threat of premature birth and using of an obstetric pessary were examined. 50 women of group I (comparison) received therapy according to the orders of the Ministry of Health of Ukraine, and 50 women of group II (main) used the treatment and preventive measures proposed by study authors, which included Banbact® suppositories for 3 days, and then Gynex® Forte complex drug for 7 days, after which a probiotic of 7 days was prescribed.Results of the study. The clinical effect of treatment in main group was achieved in 100% of cases. The amniotest was negative in all cases after treatment. In both groups was a slight shift to the alkaline side of the vaginal contents (pH 5.0–5.5), in the comparison group 2.5 times more often than in the main one. A significant decrease in the vaginal pH was observed in persons of group II after treatment at 37–38 weeks of pregnancy, no increase in pH >5.5 was detected; pH shift to the alkaline side was observed 3.5 times more often in group I.Most pregnant women in both groups achieved normocenosis after treatment. However, in group I a moderately expressed leukocyte reaction, the prevalence of leukocytes over epithelial cells, and a decrease in normal vaginal flora were noted 2.4 times more often (p <0.05). In 10.0% of pregnant women in group I single spores and pseudo mycelium of fungi, coccal or mixed flora were revealed against the background of a moderate leukocyte reaction (p <0.05).A pronounced leukocyte reaction was retained in 6 (12.0%) women of group II at 37–38 weeks, accompanied by a delay in the fetus development. Mixed flora persisted 3.7 times more often in women of group I. 22 species of microorganisms were identified in group I in the third trimester, while in pregnant women of group II – 14 species.Conclusions. The study revealed the high efficiency of complex treatment for bacterial vaginosis and normalization of the genital tract microflora in the third trimester in pregnant women with isthmic-cervical insufficiency. This helped to reduce the frequency of the threat of abortion, development of placental insufficiency, and delayed fetal development. The clinical efficacy of Banact® and Ginex® Forte was combined with their good tolerance; therefore these drugs are safe during pregnancy, which allows them to be used in practical obstetrics.

Inhibition of Porphyromonas gulae and periodontal disease in dogs by a combination of clindamycin and interferon alpha

Porphyromonas gulae is a major periodontal pathogen in dogs, which can be transmitted to their owners. A major virulence factor of P. gulae consists of a 41-kDa filamentous appendage (FimA) on the cell surface, which is classified into three genotypes: A, B, and C. Thus far, inhibition of periodontal disease in dogs remains difficult. The present study assessed the inhibitory effects of a combination of clindamycin and interferon alpha (IFN-α) formulation against P. gulae and periodontal disease. Growth of P. gulae was significantly inhibited by clindamycin; this inhibition had a greater effect on type C P. gulae than on type A and B isolates. In contrast, the IFN-α formulation inhibited the expression of IL-1β and COX-2 elicited by type A and B isolates, but not that elicited by type C isolates. Furthermore, periodontal recovery was promoted by the administration of both clindamycin and IFN-α formulation to dogs undergoing periodontal treatment; moreover, this combined treatment reduced the number of FimA genotypes in oral specimens from treated dogs. These results suggest that a combination of clindamycin and IFN-α formulation inhibit P. gulae virulence and thus may be effective for the prevention of periodontal disease induced by P. gulae.

Sinergicity test of silver nanoparticles and clindamycin against Staphylococcus aureus

Acne is a chronic inflammatory disease. The pathogenesis of acne is multifactorial; one of them is caused by an overgrowth of microbes like S. aureus. Clindamycin is one of the antibiotics recommended for acne therapy. Still, the use of clindamycin causes various side effects such as changes in intestinal function associated with intestinal flora, pseudomembranous colitis, and increases the risk of resistance. Silver nanoparticles are potent antimicrobials, have broad-spectrum activity, and can reduce the development of resistance. Despite having potent activity, the long-term use of silver nanoparticles is reported to have side effects argyria. The use of antimicrobial combinations is a strategy to reduce side effects and increase the effectiveness of therapy. Antimicrobial combinations can use low concentrations but still have the potential to inhibit microbial growth. This research aim is to determine the antibacterial synergism of a combination of silver nanoparticles and clindamycin against S. aureus. Determination of the minimum inhibitory concentration (MIC) of silver nanoparticles, clindamycin, and synergism test was carried out by microdilution using 96-well microplates. Synergy test is carried out using the Checkerboard method by calculating the value of the Fractional Index Concentration (FIC). The results showed the MIC values ​​of silver nanoparticles and clindamycin were 16 µg/ml and 64 µg/ml, respectively. The synergy test of the combination of silver nanoparticles yielding an FIC value of 0.75. Based on the result of the study, it was concluded that the combination of silver nanoparticles and clindamycin had partial synergy properties. The Minimum bactericidal Concentration (MBC) value clindamycin alone compared in combination with silver nanoparticles 16 µg/ml reduces from 256 µg/ml to 128 µg/ml. Combinations of silver nanoparticle and clindamycin are the potential to reduce side effects and overcome resistance.

Canine central nervous system neosporosis: clinical, laboratory and diagnostic imaging findings in six dogs

This report describes the clinical, neurological, laboratory and imaging findings in six dogs affected by CNS neosporosis and reviews previous publications. All dogs were born in England and never travelled...

A comparative study of Acne Vulgaris with special reference to Therapeutic options

Introduction: Acne vulgaris (AV), a human skin disease and commonly seen in adolescence. Affecting about 80–90% of teenagers in the Western population and lower rate are observed in rural societies. The present study aimed to compare the therapeutic efficacy of various drugs used in different grades of acne accordingly. Materials and Methods: This study prospective comparative study f orty patients with mild degree of acne were included as group I and 40 patients with moderate degree of acne were considered as group II. Group I patients were divided into Tretinoin(0.004%) group and Adapalene(0.1% gel). Group II patients were divided into Clindamycin (1%) group and Clindamycin 1% gel plus Benzoyl peroxide 5% cream. All these patients were given topical gel as per the dosage schedule over a period of 12 weeks. The change occurred in acne lesions were recorded every 2 weekly follow-up using global assessment improvement scale. Results: Efficacy and cutaneous tolerance were assessed at baseline and 2,4,6,8,10 and 12 weeks. At the end of 12 weeks treatment, 75% of patients using Tretinoin showed good response to excellent response and 25% patients showed poor to fair response. At the end of 12 weeks treatment, 80% of patients using Adapalene showed good to excellent response. There is no significant difference between two groups. Topical Adapalene is eqally efficacious as Tretinoin. At the end of 12 weeks treatment, 45% of patients using only Clindamycin showed good to excellent response. While 90% of patients using both Clindamycin and Benzoyl peroxide showed good to excellent response. Combination of Clindamycin 1% gel with Benzoyl peroxide cream more efficacious than Clindamycin 1% gel alone in reducing the number of lesions in grade 2 acne. Conclusion: The present study showed there is n o significant difference between Adapalene (0.1%) and Tretinoin (0.04%) after 12 weeks of treatment. Significant reduction in number of inflammatory and total lesions were demonstr

1132. Evaluation of Broad-Spectrum Antimicrobial Therapy for Acute Mastoiditis in Pediatric Patients: An Antimicrobial Stewardship Perspective

BackgroundAcute mastoiditis (AM) continues to remain a serious complication of acute otitis media in children. There is a significant variation in antimicrobial management in children with AM. Recent studies and UptoDate recommends empiric coverage with vancomycin and antipseudomonal medication in patients with AM. The purpose of this study was to evaluate the epidemiology, management and outcome of AM in pediatric patients.MethodsA retrospective, observational study was designed evaluating epidemiology and management of AM in hospitalized pediatric patients from July 1, 2011 to June 30, 2017. Patients between 6 months and 19 years of age admitted with a diagnosis of AM as per ICD 9/10 coded were included in the study. Information regarding demographic, clinical, laboratory, microbiological, radiological, antibiotic (Abx) usage, surgical intervention and outcome were collected from medical records.ResultsA total of 97 patients were evaluated (64% male, mean age 6.6 ± 4.3 years). Cultures (Cx) were obtained in 95 patients as in Figure 1. Of the patients who grew P.aeroginosa, 2 had intracranial extension, both of which were polymicrobial and 5 did not receive empiric antipseudomonal therapy but had no complications on follow-up. Table 1 shows the most common empiric Abx therapy. Fifty-nine patients (61.5%) had a change in Abx, the most common being a ceftriaxone or a combination of clindamycin and ceftriaxone. Except for those with complicated AM, none required definitive vancomycin therapy. Thirty-two patients (33%) had a complicated mastoiditis with epidural abscess, thrombosis, and/or intracranial extension. Eighty-six patients (86.8%) required surgical intervention. Mastoidectomy was performed in 34% while others had myringotomy and tympanostomy tube placement and/or drainage of subperiosteal abscesses without subsequent complications.Conclusion Group A Streptococcus, Streptococcus pneumoniae and Pseudomonas were the predominant pathogens in acute AM in children. Vancomycin and empiric antipseudomonal coverage may not be needed in patients with uncomplicated AM. Broader spectrum Abx with intracranial penetration should be reserved for those with complicated AM. Disclosures All authors: No reported disclosures.

Redundant combinations of antianaerobic antimicrobials: impact of pharmacist-based prospective audit and feedback and prescription characteristics.

This study aimed to evaluate the impact of the intervention targeting the redundant combination of antianaerobic antimicrobials on its incidence and associated antimicrobial consumption. To reveal the characteristics of the combination and the change in the related workload over time was an additional aim of the study. The combinations of metronidazole or clindamycin with antianaerobic antimicrobials were classified into redundant or acceptable, according to the target indications. A pharmacist-based prospective audit and feedback targeting the redundant antianaerobic combination was conducted. Segmented regression analysis was performed to evaluate the impact of the intervention. As a quantitative index of the interventional activity, the change in the number of signed consultation notes was evaluated. After the initiation of the intervention, the median monthly cumulative incidence of the redundant combination decreased from 5.29 (Interquartile range [IQR] 4.94-5.70) to 3.33 (IQR 2.87-3.71) (p < 0.001) per 1000 admissions per month. The consumption of concurrently administered metronidazole and clindamycin decreased from 3.34 (IQR 2.97-4.10) to 1.74 (IQR 1.19-1.93) (p < 0.001) per 1000 patient-days per month. Segmented regression analysis revealed that the monthly cumulative incidence decreased by 28.5% after the initiation of the intervention (change in level - 1.640, p = 0.019) and the monthly consumption decreased by 33.9% (change in level - 1.409, p = 0.009). The number of consultation notes per 1000 admissions per month decreased over time (regression coefficient - 0.004, p < 0.001). The pharmacist-based intervention significantly reduced the incidence and associated antimicrobial consumption of the redundant antianaerobic combination. The overall related workload reduced steadily over time.

Anti-Mycoplasma Activity of Daptomycin and Its Use for Mycoplasma Elimination in Cell Cultures of Rickettsiae.

Mycoplasma contamination detrimentally affects cellular functions and the growth of intracellular pathogens in cell cultures. Although several mycoplasmacidal agents are commercially available for sterile cell cultures, they are not applicable to rickettsia-infected cells. In our attempt to find an anti-mycoplasma drug for contaminated rickettsial cultures, we determined the susceptibilities of three common Mycoplasma species to daptomycin. Mycoplasma orale and M. arginini showed low-level resistance to daptomycin (minimum inhibitory concentration, MIC = 2 mg/L), whereas M. hyorhinis was high-level resistant (MIC = 32 mg/L). However, some Mycoplasma isolates developed higher resistance to daptomycin after failed treatments with inadequate doses or durations. An aminoglycoside (gentamicin) was still active against M. hyorhinis and could be used in Orientia cultures. For complete eradication of mycoplasmas in Rickettsia cultures, we recommend a 3-week treatment with daptomycin at 256 mg/L. In contaminated Orientia cultures, daptomycin at 32 mg/L was effective in eradicating M. orale, whereas either gentamicin or amikacin (100 mg/L) was effective in eradicating M. hyorhinis. Unlike each drug alone, the combinations of daptomycin plus clindamycin and/or quinupristin/dalfopristin proved effective in eradicating M. hyorhinis. In summary, our study demonstrated the in vitro anti-mycoplasma activity of daptomycin and its application as a new mycoplasma decontamination method for Rickettsia and Orientia cultures.

MON-179 UTILITY OF CLINDAMYCIN AND PRIMAQUINE FOR PNEUMOCYSTIS PNEUMONIA IN RENAL TRANSPLANT RECIPIENTS

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. PJP occurs in approximately 5–15% of transplant patients, depending on the transplanted organ and the degree of immunosuppression. In the absence of appropriate treatment, the mortality rate of PJP is 90–100%, and can be as high as 50% despite adequate therapy. Trimethoprim-Sulphamethoxazole (TMP-SMX) is the first choice for the treatment of PJP. Alternative drugs include intravenous Pentamidine, Dapsone, combination of Clindamycin and Primaquine (C+P).

High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C. This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia. The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005). The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.

Monomicrobial non-neutrocytic bacterascites caused by aeromonas hydrophila in a patient with liver cirrhosis.

Aeromonas peritonitis is a rare, but serious infection, as associated with spontaneous bacterial peritonitis, peritonitis in chronic ambulatory peritoneal dialysis, and intestinal perforation. Here, we reported a case of monomicrobial non-neutrocytic bacterascites caused by Aeromonas hydrophila (A. hydrophila). The patient, a 57-year-old man who had a history of alcoholic liver disease and chronic hepatitis C-related Child- Pugh class C liver cirrhosis, was admitted to our hospital with fever, dyspnea and a localized wound pain over left ankle. Ascitic fluid analysis demonstrated that ascitic polymorphonuclear cell count was 30 cells/ mm3. Empirical antimicrobial treatment with a combination of ceftriaxone and clindamycin were administered. However, the patient died due to fatal septic shock on Day 3. His blood and ascites cultures were positive for A. hydrophila. The case report presents the diagnosis, management, and literature review of Aeromonas monomicrobial non-neutrocytic bacterascites.

BAD guidelines for the management of HS (acne inversa) 2018

Hidradenitis suppurativa (HS) is a long‐term skin condition causing multiple boils in skin creases such as the arm pits and groins. The boils are painful and produce pus, and permanent scarring occurs as the disease progresses. As a result, it has a large impact on quality of life. HS affects about 1 in 100 of the UK population and it tends to start in early adulthood. The British Association of Dermatologists commissioned a HS guideline development group composed of information specialists, a HS patient and carer, and UK clinicians including dermatologists, a dermatology nurse, plastic surgeon and general practitioner (GP). The group, based in the UK, were asked to produce treatment recommendations based on a systematic review of the evidence. The evidence was converted to recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Nearly 3000 evidence records were identified through database searches. Initial recommendations for HS management by GPs and hospital clinics include to provide a patient information leaflet, record baseline disease severity, measure pain and treat if needed, measure quality of life, record a count of skin lesions, and provide wound dressings if required. Patients should be screened for cardiovascular disease risk factors as well as for depression and anxiety. Patients should also be offered smoking cessation and weight management referral if relevant. A treatment ladder of medical therapy is recommended, starting with oral tetracyclines, then the combination of clindamycin and rifampicin, acitretin in men and non‐fertile women, dapsone and progressing to adalimumab injections if required. Surgical treatment with wide removal and a range of closure methods is placed towards the end of the medical treatment pathway, reflecting current UK practice and a relative lack of evidence. Future research recommendations and audit criteria are included.

Analysis of screening strategy of group B streptococcus in the third trimester and its influence on pregnancy outcome

Objective: To investigate the screening strategy of group B streptococcus (GBS) in the reproductive tract of women in the third trimester and analyze its impact on pregnancy outcome. Methods: A total of 85 461 pregnant women in 35-37 weeks of gestation from Bao'an Maternity and Child Health Hospital, Jinan University from January 2011 to June 2018 were enrolled. They were divided into 3 periods according to different GBS screening strategies, the unscreened period included 31 384 cases (36.72%), 33 267 cases (38.93%) were included in partial screening period, 20 810 cases (24.35%) were included in screening period. All GBS screening positive pregnant women were given intrapartum antibiotic prophylaxis (IAP). The impact on pregnancy outcomes, and the impact of different GBS collection transport and culture methods on the positive rate of GBS screening were analyzed. Results: (1) The incidence of neonatal early onset GBS disease (EOGBSD) in unscreened period was 0.03% (11/31 773), in partial screening period was 0.02%(6/33 887), and in screening period, the incidence of neonatal EOGBSD decreased to 0, the difference was statistically significant (χ(2)=7.86, P=0.02).(2) The incidence of hematogenous infection of GBS in pregnant women was 0.02%(6/33 887) in partial screening period, and there was none in screening period, there was no significant difference (adjusted χ(2)=3.75, P=0.05). (3) In the screening period, the positive rate of GBS was 14.08%(2 719/19 306), which was significantly higher than the positive rate of GBS in the partial screening period (11.48%, 2 058/17 920; χ(2)=56.12, P=0.00). (4) Antibiotic sensitivity tests of 4 777 GBS strains showed that the antibiotics with higher resistance rate were tetracycline (81.52%, 3 896/4 777), erythromycin (66.59%, 3 181/4 777), and clindamycin (64.31%, 3 072/4 777). The combination of erythromycin, clindamycin and tetracycline was the most common resistant pattern, accounting for 48.80% (2 331/4 777). No penicillin, ceftriaxone or vancomycin resistant strains was found. Conclusions: GBS screening strategy in different regions could combine the local neonatal EOGBSD incidence rate, maternal GBS colonization rate, and the socioeconomic factors to determine whether universal GBS screening or screening for high-risk maternal women. GBS screening positive rate is related to the population, scope of the investigation, the sample collection, delivery and culture methods. The multi-drug resistance rate of GBS is high.

Minimum 5 years' follow-up after gentamicin- and clindamycin-loaded PMMA cement in total joint arthroplasty.

Due to numerous advantages of the combination of clindamycin and gentamicin in polymethylmethacrylate (PMMA) cement, promising preliminary results have been reported. However, there are no data that analyse mid-term outcomes. This pilot study included patients who experienced 5 years of follow-up and who were treated with gentamicin- and clindamycin-loaded (G+C) PMMA cement. They were divided into two groups: (1) the periprosthetic joint infection (PJI) comprising patients who underwent a one-stage exchange, and (2) aseptic group comprising patients who underwent aseptic revision or primary arthroplasty procedures, but were considered to be high-risk patients for infection. We evaluated the rate of septic and aseptic revision arthroplasty with a minimum of 5-year follow-up.Results/Key findings. A total of 32 patients in both groups were included. Eighteen patients belonged to the PJI-group and 14 belonged to the aseptic group. There was no reinfection among the patients of the PJI group. Infection was prevented in the aseptic group, including patients with a history of PJI or at higher risk of infection. No patient underwent an exchange of the cemented prosthesis at the 5-year follow-up [72-82 months, standard deviation (sd)=3.3]. The local use of G+C bone cement during septic and aseptic revision arthroplasty, was associated with a high success rate for the eradication of infection following one-stage septic exchange, and with prevention of infection in high-risk patients.

Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients.

Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

Combination of clindamycin and primaquine for Pneumocystis pneumonia in renal transplant recipients

Pneumocystis pneumonia (PCP) in kidney transplant recipients is usually treated with trimethoprim-sulfamethoxazole (TMP-SMX). Combination of clindamycin and primaquine (C + P) is recommended for treatment failure. Data are scarce for treatment with C + P in renal transplant recipients. Here, we present three kidney transplant recipients on triple immunosuppression (tacrolimus, mycophenolate mofetil, and prednisolone) diagnosed to have PCP at different time periods after transplant surgery. Bronchoscopy and lavage were done; special staining with Gomori methenamine silver stain demonstrated Pneumocystis jirovecii. Two patients had graft dysfunction at the time of diagnosis. The first patient was started on TMP-SMX but developed leukopenia and was started on oral C + P. The other two cases had graft dysfunction and were started on C + P. All responded to therapy without complications, and improvement in graft function was observed. Clindamycin with primaquine can be considered as a safe and effective option to treat PCP in renal transplant recipients; this combination can replace TMP-SMX, as the first-line therapy, especially in patients with graft dysfunction or leukopenia

Successful Treatment of Necrosed Primary Molars Using LSTR Technique by a New Combination of Antibiotics: A Case Series

Introduction: In this study we used combination of amoxicillin, metronidazole and clindamycin for treatment of 3 patients with infected primary molars until eruption of the first molars. Materials and Methods: A single session LSTR was done using combination of ciprofloxacin, metronidazole and andclindamycin at the ratio of 1:1:1. Conclusions: After 12- to 13-month follow-ups, the combination can greatly help save hopeless infected primary molars before eruption of permanent first molars due to effective space maintenance.

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa.

The rifampicin (RF)-clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy. The aim of the present study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS. In the period January 2017-May 2018, 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by Revuz, Hidradenitis Suppurativa Physician Global Assessment [HS-PGA] and International Hidradenitis Suppurativa Severity Score System [IHS4]) before (W0) and after (W12) CL oral therapy. CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12-week period (p ≤ .01). There was also a statistically significant change in the mean visual analogue scale for pain. The present study demonstrates the efficacy of oral CL monotherapy as RF-sparing regimen alternative to RF-CL combination in a selected group of patients.

Efficacy of Antimicrobial-Impregnated External Ventricular Drain Catheters: A Prospective, Randomized, Controlled Trial

AbstractBackground: Insertion of External Ventricular Drain (EVD) is associated with considerable risk of Cerebrospinal Fluid (CSF) infection which is a life-threatening complication. Infection occurs when microorganisms colonize along the catheter surface.Aim of Study: The aim of this study is to compare the safety & efficacy of EVD catheters impregnated with Clin-damycin & rifampin with those of standard control catheters for prevention of the catheter-related infections.Subjects and Methods: The prospective study was con-ducted on forty patients between April 2013 – November 2014. All patients were randomly assigned to undergo place-ment of an EVD with a catheter impregnated with Clindamycin & rifampin or a standard non-impregnated catheter (control group). Each group included twenty patients. Standard silicone catheter was the EVD used in both cohorts. Patients diagnosed with a known or suspected CSF infection were excluded from this study. Initial cell counts and cultures were obtained from the CSF, repeated at intervals (72 hours) and at time of Catheter removal. CSF infection rate and its impacton the clinical outcome were evaluated in both groups.Results: Among this series of forty patients with EVDs, three had an EVD-associated CSF infection in the control group giving an infection rate within this group of 15% per patient. Only one case in the Antibiotics-impregnated Catheter (AIC) group had CSF infection. Positive CSF cultures were obtained on day 10, 12 & 14 respectively. Organism isolated from CSF cultures was mainly gram-negative infection. AIC group showed a significant low infection rate compared to the uncoated one (p<0.001).Conclusion: The Catheters impregnated with the antibiotic combination of Clindamycin and rifampin appears to be safe and effective in reducing the risk of infectious complications associated with the placement of an EVD.

Long-term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. A Critically Appraised Topic.

Can therapy with clindamycin and rifampicin be safely continued long term beyond the recommended 10-week course? Clindamycin and rifampicin are used in combination to treat hidradenitis suppurativa (HS). There is no data on the efficacy and safety of clindamycin/rifampicin combination therapy for HS beyond 10 weeks. We identified the following major concerns that still lack a proper evidenced-based analysis: for rifampicin, drug-induced liver injury, interstitial nephritis, drug interaction and hepatic p450 3A4 enzyme induction; for clindamycin, the concern was community-acquired Clostridium difficile infection (CA-CDI); and experience with long-term treatment. Data sources were used as appropriate to answer the question. Systematic searches were used to assess the risk of CA-CDI and experience with long-term treatment with clindamycin. The risk for rifampicin-induced liver injury is highest in the first 6 weeks of treatment, whereas interstitial nephritis is primarily observed during intermittent treatment. Enzyme induction due to rifampicin is usually complete after about 2 weeks of treatment and reduces clindamycin blood levels by about 90%. Three meta-analyses identified antibiotic use as a risk factor for CA-CDI. Two of them assigned the highest risk to clindamycin. None of them stratified by length of treatment. There is extensive experience with rifampicin, primarily for the treatment of tuberculosis. Long-term experience with clindamycin is limited. The analysed risks associated with a combination of clindamycin and rifampicin for hidradenitis suppurative cluster within the first 10 weeks. Treatment can be continued beyond 10 weeks, if clinically necessary.